A Journalist’s Guide to Covering Bioterrorism Second Edition

Radio and Television News Directors Foundation News Content and Issues Project Published with the generous support of Carnegie Corporation of New York

Bioterrorism

A Journalist’s Guide to Covering Bioterrorism Second Edition

By David Chandler and India Landrigan • Made possible by the generous support of Carnegie Corporation of New York

Radio and Television News Directors Foundation • President, Barbara Cochran • Executive Director, Deborah Potter Editors: Mary Alice Anderson, Loy McGaughy Project Advisers: Jerome Hauer, Dr. Phillip Landrigan, Scott Miller, David Ropeik Copyright ©2004 by the Radio and Television News Directors Foundation (RTNDF). All Rights Reserved. No part of this publication may be reproduced in any form or by any means without permission in writing from RTNDF. Printed in the United States of America.

The version of this guide that appears on RTNDF’s web site may be downloaded for individual use, but may not be reproduced or further transmitted without written permission by RTNDF. A JOURNALIST’S GUIDE TO COVERING BIOTERRORISM

Table of Contents

Foreword ...... 3

Why This Guide Is Needed...... 5

What Is Bioterrorism?...... 7

When Biological Weapons Have Been Used...... 11

How a Biological Attack Might Unfold ...... 15

Possible Bioweapons ...... 18

Laws and Treaties That Govern Biological Weapons ...... 31

Who Has Biological Weapons ...... 35

What Can Be Done for Defense...... 38

Where to Get Information...... 42

Glossary ...... 46 A JOURNALIST’S GUIDE TO COVERING BIOTERRORISM

Foreword

Journalists usually are uninvolved observers, reporting on events as they unfold. But as we know all too well—after the September 11 attacks on New York and Washington—when anthrax hit, journalists and news organizations themselves became part of the story. Being in harm’s way is nothing new to the news people who cover wars, natural disasters or other emergencies. Veteran journalists know how to deliver such stories without causing undue alarm, but covering bioterrorism presents a unique set of challenges. Public perceptions may, and likely will, play a deciding role. As it was on September 11 and in the days immediately following, media performance will be critical. If the public panics, responses by government and health authorities may be affected. For example, if a bioterror attack led authorities to impose isolation or quarantine policies and something about the reporting led people to disregard the policies, containing the infection could become more difficult, leading to further deaths. Or, if a frightened public overwhelms hospital and public health facilities, chaos could ensue. Obviously, the opposite also is true: Helpful information, disseminated quickly and effectively, will go a long way toward preventing major disruptions. This is a new kind of problem—for the United States and for the world, for the first-response emergency personnel and for the journalists reporting on them. Thankfully, no one yet has a wealth of experience in responding to bioterror attacks. Unfortunately, that could change. The better prepared we all are to play our respective parts during the heat and confusion of an emergency, the better we will be able to do our jobs. And that’s why RTNDF has prepared this handbook—as one way to help journalists prepare for covering bioterrorism. There is a massive difference between a crisis and a catastrophe, and in the case of bioterror attack, the effects of media coverage on public perception could be the deciding factor between the two. Although we hope none of us ever will need to know the kind of detailed information provided here, we have gathered facts, background information and resources and have presented them in what we hope is an easy-to-use format. Please read this guide now, before you need it, and keep it handy. Should a bioterror attack occur, your viewers and listeners will need critical information, delivered quickly, accurately and in the proper context. We hope this guide serves as one of the many tools you use to deliver the news to a public in need.

Special thanks to Carnegie Corporation of New York for providing the funding that enabled RTNDF to prepare this essential publication and to update it in response to strong demand.

Barbara Cochran President, Radio-Television News Directors Association and Radio and Television News Directors Foundation April 2004

3 4 A JOURNALIST’S GUIDE TO COVERING BIOTERRORISM

Why This Guide Is Needed

The very nature of an attack using biological weapons can present a unique set of difficulties and challenges for reporters, editors and producers as they struggle during a rapidly unfolding event to present the facts as clearly, objectively and dispassionately as possible.

For example, during the anthrax attacks in information by misguided officials, can make the October 2001, some journalists suddenly found situation much worse—for example, creating public themselves in the middle of the story. They had panic that may be the true objective of the attacker. become specific targets and potential victims of the Conversely, a quick release of the straight, basic facts, very attacks they were reporting on when an restrained reporting and the use of knowledgeable anthrax-laced letter was found at the headquarters and balanced sources can play an important role in of NBC News in New York City and an assistant to controlling needless public fears, disseminating anchorman Tom Brokaw tested positive for the important information about protective measures, disease. Employees at both ABC News and CBS and encouraging rational responses. News also were possible targets and potential There is ongoing debate about exactly how much victims although the actual contaminating letters information to release, when and in what form — a Some journalists were never found in either location. More broadly, it debate that intensified in the wake of the 2001 suddenly found appeared the media in general were being targeted. attacks. Thomas Glass, an epidemiologist and The initial attack was in a letter addressed to sociologist at Johns Hopkins University, published a themselves in the American Media headquarters in Florida, publishers study in December 2001 saying that during the middle of the of a variety of supermarket tabloids, and another anthrax attacks, officials were so intent on averting anthrax-laced letter was received at the New York panic that they withheld some information from the story. They had Post. The attack had become personal, and public and distorted other information. The result, maintaining an impartial demeanor on camera he said, was actually the reverse: People are more become specific became unusually difficult. likely to panic as a result of lack of information. targets and In general, the slow and gradual unfolding of a Numerous studies of emergency responses have biological attack can leave a long interval when there shown that when told the truth about a disaster potential victims is uncertainty about many of the crucial facts: the (natural or human-induced), people tend to remain of the very exact location or extent of the initial release; the type calm and organize themselves to help those who of biological agent used; its level of volatility, have been affected. Among the lessons to be learned, attacks they were virulence and stability over time; or the likelihood of according to several specialists in risk reporting on. additional releases that could take place, or might communication, is that a knowledgeable, official already have taken place but have not yet produced source should have been made available to the press symptoms. Uninformed public speculation during as a regular daily event, and more information this period of maximum uncertainty, or a vacuum should have been provided about measures citizens of information caused by the withholding of could take to protect themselves.

5 A JOURNALIST’S GUIDE TO COVERING BIOTERRORISM

Lee Clark, a sociologist at Rutgers University, has very difficult to locate knowledgeable sources for done research that emphasizes this point. He has specific, detailed and realistic information. Initially, found that while public officials and analysts even the nature of the biological agent may be typically cite the risk of panic as a reason for unknown, adding to the difficulty of providing controlling or withholding information, the fact is useful information. Whatever on-air sources can be Some government that panic—defined as group action that is found on very short notice—including perhaps irrational and does not serve people’s interests—is local doctors, police or fire officers, or academic officials have extremely rare in crisis situations. It is far more experts—may find themselves trying to explain discussed the common for people to go to extraordinary lengths specific diseases and distribution mechanisms about to help one another and work together to deal with which they have had little training or exposure. At possibility of the problems they face. worst, the risk is that their varying, possibly adding a new And yet, fearing the possibility of letting out facts conflicting, perspectives could add to the public’s that might prove helpful to the terrorists by confusion and fear. At best, clear accurate category to revealing vulnerabilities they might not have information and level-headed reporting on a certain published considered, some have advocated the reverse policy bioterror event can significantly and constructively of further restricting the flow of information. Some affect public perception—possibly even keeping a research, calling government officials have discussed the possibility crisis from becoming a catastrophe. of adding a new category to certain published This book is an attempt to provide some guidance it “sensitive but research, calling it “sensitive but unclassified.” In an for those who may suddenly find themselves faced unclassified.” editorial in the journal Science (11/8/02, p. 1135), with the need to make quick decisions and provide the presidents of the U.S. National Academy of information in the event of a possible bioterror Sciences and the British Royal Society wrote that this attack in the United States or elsewhere today. We idea would “generate deep uncertainties” among have attempted to give concise and up-to-date, basic scientists. Such a measure “makes the best scientists background information on some biological agents reluctant to work in the affected area, stifles believed to pose the greatest threat. The goal is to creativity in fields where it is most needed for help working journalists increase the quality of their defensive purposes, and consequently weakens reporting and analysis concerning a bioterror event. national and international security.” Still, they point The guide provides detailed information about out this does not mean that everything should be the six biological agents the U.S. Centers for Disease published. “Researchers in the biological sciences Control and Prevention (CDC) has identified as the need to take responsibility for helping to prevent the most likely to be used as biological weapons, in potential misuse of their work,” they wrote. addition to brief descriptions of many other agents In the United States, and indeed in the rest of the that, though considered less likely, have also been world, there has been little experience in responding developed as weapons or may be in the future. This to bioterror attacks—either by “first response” guide also contains a detailed glossary to help paramedics, police and emergency room personnel, journalists navigate the complicated array of or public health officials and the media—increasing scientific terms, jargon and obscure acronyms they the difficulty for all involved in getting reliable may encounter in covering a biological attack. information or knowing how best to proceed. The Finally, we have also included a list of resources: unfolding of such an attack will not be like government, military and academic Internet sites witnessing an explosion. There may not be any that can be trusted to give reliable information; footage of an attack to replay or a specific scene to agencies and associations that can provide referrals shoot. Lacking a defined “crime scene” and likely to local experts; and a few useful books and CD- having little time to prepare, news teams may find it ROMs to turn to for more detailed information.

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What is Bioterrorism?

The State Department defines terrorism as “premeditated, politically motivated violence perpetrated against noncombatant targets by subnational groups or clandestine agents, usually intended to influence an audience.”

The attacks against the United States on federal and local, will be responsible for keeping the September 11, 2001, brought this definition into media informed. The public will in many cases rely question. The scale of the attacks suggested more of on the media for basic information about the event, a global, ideological motivation than a solely including the nature of the biological agent and its political motivation. In the 1970s, terrorists typically effects and characteristics, measures that can or are shied away from atrocious crimes that would scare being taken by public health officials or local health away potential supporters. Today, terrorists workers, and advice on steps that citizens can take to increasingly aim for mass casualties, panic and protect themselves and recognize signs of disease in death. In the years since that attack, while there have themselves or in their communities. been no further mass incidents on U.S. soil, other Journalists should remain aware that the quality large-scale terrorist attacks have taken place in of coverage, in addition to the quality of decision This new Indonesia (on the island of Bali in October 2002), making at all levels, could make or break the terrorism could Iraq (especially after the war was declared over by response to a bioterror attack. For example, overly U.S. officials), and Spain (in Madrid in March 2004). vague descriptions of likely symptoms or use anything The advent of mass-casualty terrorism—and the exaggerated accounts of possible outcomes could from salmonella reports of some terrorist organizations’ pursuit of lead to hospitals being overwhelmed with the unconventional chemical, biological, radiological “worried well” (those who are asymptomatic or and smallpox to and nuclear weapons—indicates that the world is have mild symptoms not indicative of infection but dirty bombs and seeing a new type of terrorism altogether. According who seek medical treatment out of concern). In to a book by Jessica Stern, a former U.N. Security large numbers, the worried well can severely hamper hijacked airplanes Council staff member, incidents of terrorism or even disable a hospital’s or public health system’s increased fivefold since the 1970s (even before the ability to treat those actually exposed or infected. as weapons of attacks of 2001), and the number of people killed One of the biggest problems for journalists trying mass destruction. per attack had doubled. This new terrorism could to cover a bioterrorism incident concerns the use anything from salmonella and smallpox to dirty uniquely stealthy nature of a bioterror attack, which bombs and hijacked airplanes as weapons of mass could remain undiscovered for days or even weeks destruction. until health workers start to notice unusual Terrorism is not just about inflicting harm or infections or unusually high numbers of similar damage; it is about instilling fear. Even hoaxes and illnesses. Any attacks involving chemical, nuclear, threats can terrorize large populations, causing radiological and other weapons of mass destruction social and economic harm even when no real are likely to require a conventional “lights and danger exists. Various government agencies, sirens” response, providing an obvious focal point

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for media coverage and opportunities for Much of the information the United States now interviews with myriad experts about chemicals, has on such agents comes from research conducted radiation, building collapse or other relevant and by the U.S. military before President Richard Nixon relatively well understood topics. Bioterror will be halted the U.S. offensive biowarfare program in different. Biological weapons could be just as 1969, and from research of the former Soviet The differences destructive as chemical and nuclear weapons, but Union’s massive biowarfare program, Biopreparat, they are all the more frightening because they which lasted into the 1990s. This research has led between nuclear strike silently, invisibly, and may not even be authorities to pinpoint a handful of agents believed or chemical discovered until long after the attack, giving the to possess the combination of lethality and ease of attackers plenty of time to flee far from the scene. dissemination that make them the likeliest agents for attacks and These circumstances will raise particular issues a bioterror attack. A later chapter discusses these biological attacks for journalists. Without a discernible scene or agents in greater detail, focusing on the six now “ground zero,” there will be no heroic fire, police believed by the Centers for Disease Control and can be compared or emergency medical personnel rushing to a Prevention to pose the greatest threat, as well as brief to the difference precise location. Without reassuring, visible descriptions of some of the other possible, though response efforts at the scene of the attack, an considered less likely, biological agents. between air information vacuum could cause the public’s level of fear to rise. As news organizations seek Biological vs. Chemical and strikes and answers from experts and government officials, Nuclear Weapons sabotage inexperience, limited knowledge or a reluctance The differences between nuclear or chemical to share information on the part of some of these attacks and biological attacks can be compared to missions. sources could create further confusion and the difference between air strikes and sabotage possibly even panic. missions. While both are methods of attack, they Bioterrorism can range from putting waste are based on different technologies, unfold matter into food in a small-town restaurant to the differently and have vastly different effects. Aside aerosolized release (dispersing an agent in a par- from usually being detectable by smell and ticulate form) of a contagious virus over a large sometimes by sight (as in the greenish-yellow color city, or even the spreading of plant or animal dis- of chlorine gas), chemical agents work by creating eases in farming areas to disrupt the nation’s food relatively immediate physical effects in those supply. The perpetrator can be anyone from a dis- exposed—usually via the skin, respiratory system, gruntled employee to a hostile foreign nation or digestive system and/or neurological system. transnational terrorist group. The type of biolog- Decontamination usually attenuates the ical agent used, the means of dissemination, and symptoms, and while high levels of exposure may the effectiveness of the response, as well as unpre- have fatal or lingering effects, the attack is over as dictable variables such as rainfall and wind, will soon as the chemical no longer is being determine how many people are affected over disseminated. The immediate and finite aspects of how wide an area, and how severe their symptoms chemical weapons make them comparable to an air are. Theoretically, the number of potential biolog- strike; the attack has a noticeable beginning, it ical agents is almost limitless, but certain agents inflicts damage and ends quickly, and it allows naturally have a combination of properties (such damage assessment and consequence management as hardiness, transmissibility and virulence) that to begin almost immediately. Nuclear weapons, even make them most effective as weapons. Several of more so than chemical, produce a dramatically these have been developed and tested for use as obvious initial blast that causes immediate damage biological weapons, and these are the ones con- in a clearly defined area. Unlike chemical weapons, sidered most likely to be used in a terrorist attack. however, nuclear contamination can also leave a

8 A JOURNALIST’S GUIDE TO COVERING BIOTERRORISM lasting legacy of latent, invisible cancers and calls, hospital admissions and even drug store mutations that may take decades to develop. purchases. Some cities and states are much more In the case of biological weapons, the crisis is advanced than others in this regard. measured in weeks and months, not minutes and Hand-held machines meant to “sniff” the air and hours. Even the fact that an act of biological detect certain agents are under development in a terrorism had taken place could, and probably number of research laboratories, but so far they From a practical would, escape detection for days or weeks because have not met expectations for accuracy and detection currently depends on public health dependability; both false negatives and false standpoint, systems’ ability to recognize unusual infections or positives can have dangerous consequences. Larger chemical weapons upsurges in reported symptoms—symptoms that detection machines are currently under initially might resemble nothing more serious than development, but no systems have yet proved are often easier the flu. In this sense, a biological attack is more like themselves suitable for widespread national and cheaper to an undercover sabotage mission—the destructive deployment. Some may be close, however. One blow is not immediately apparent and only time will system, developed by scientists at the California produce and reveal the attack’s nature and extent. Institute of Technology and NASA’s Jet Propulsion easier to deploy Whereas chemical or nuclear weapons attacks Laboratory, could continuously monitor the air to would be followed by a large, immediate response by detect spores—either as a tracer of various than biological federal response teams and/or local fire departments biological weapons, or in some cases such as and emergency medical services, biological attacks anthrax, the agent itself. Such systems could weapons. would produce a delayed response requiring function as a kind of bioweapons “smoke alarm,”the difficult coordination among local hospitals, state scientists say, especially in large public spaces such as and local public health departments, and the federal airports and train stations, stadiums and concert public health system. Moreover, the appropriate halls. Until such detection systems are fully response depends not only on noticing that an developed, tested and deployed, the nation must rely attack has occurred but also on determining the on the vigilance of the public health community and specific agent used and its method of dissemination. the news media to notice when something is amiss A spike in flu-like symptoms in an East Coast city and thereafter on the federal laboratory response may well indicate an upsurge in flu cases, but it also network to quickly hone in on the identified could be the first sign of anthrax or smallpox, both biological agent. of which require that vastly different response From a practical standpoint, chemical weapons measures be taken as quickly as possible. In other are often easier and cheaper to produce and easier to cases, as in some recent real and hoax incidents, deploy than biological weapons. Chemical weapons there may be obvious signs of an agent, such as often are closely analogous to industrial-use mysterious powder found in an envelope containing chemicals (e.g., the nerve agents Sarin and Tabun are a cryptic or threatening message. In such cases, the closely related to industrial pesticides). Therefore, response is often more similar to the response to a terrorists can steal industrial chemicals to use as chemical attack, with a roped-off crime scene and weapons, and due to the commercial use of these hazardous-material (hazmat) teams responding in chemicals, the technology to manufacture them is full protective gear and breathing apparatus. If the relatively widely circulated and relatively easily attack is thus visibly localized, that may allay people’s copied. By contrast, the technology, materials and fears about its uncontrolled spread. expertise required to develop nuclear weapons are Presently, no national “early warning system” by far the most expensive and difficult of all the so exists for biological agents. However, detection on a called “weapons of mass destruction.” For example, local level has advanced greatly in the past decade to one U.S. government study concluded that nuclear include systems that analyze data from ambulance weapons would cost $1,500 per person killed, while

9 A JOURNALIST’S GUIDE TO COVERING BIOTERRORISM anthrax could cause deaths at a cost of just a penny minimum cost. Some studies estimate that anthrax each. The contrast is so great that biological spores, correctly prepared, could be 1,000 times weapons have been referred to as the “poor man’s more lethal and could infect an area 1,000 times nuclear weapon.” larger than the same weight of Sarin, one of the The technology required to grow biological more potent chemical nerve agents. In addition to agents is much more advanced than that required potentially extreme physical harm, the most to mix chemicals, and in most cases a much higher widespread damage caused by a biological agent level of expertise is needed as well—although it is may well be psychological. In some cases, there will possible that new techniques developed for be no clearly defined specific area to fear and avoid, biological research or pharmaceutical production so instead people may develop a generalized fear of could change that. Dissemination of a biological public places, going outdoors, opening the mail or agent involves not just getting the agent into water, even breathing. A well-defined contaminated area, food or the air; it involves a painstaking, complex as is likely in a chemical or even nuclear attack, is process of refining the agent to the right size and much easier to comprehend and accept than a form to infect humans while maintaining both dangerous biological agent at large in the air. stability and virulence. Biological weapons also in While a chemical weapon may have a some cases carry a greater risk to those producing devastating impact, the human toll will be finite them—accidental infection or contamination are and calculable within hours, even minutes, of an both likelier and, because the contamination may attack. Many may die or be permanently affected not be immediately apparent and could lead to by the chemical, and some areas may require secondary infections among those who come in lengthy and costly decontamination. In theory, contact with the infected person, potentially the impact of a biological attack could be far deadlier than in the case of chemical weapons. greater, because of the potential for person-to- Stories of accidental infection and dissemination person spread of the infection after the initial from the Soviet biowarfare labs in the 1970s and attack (though this is not the case for agents such ‘80s still are emerging. as anthrax or botulism). The physical toll will not Biological weapons’ potential for delivering be known until every person possibly exposed has widespread human damage even from a small-scale passed the time limit for developing symptoms, release, however, may outweigh their expense and and this uncertainty can add greatly to the attack’s danger if the intent is to cause maximum harm at psychological toll.

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When Biological Weapons Have Been Used Biological warfare and bioterrorism have been rare in the history of the world, but the technology involved and the potential methods of attack have advanced rapidly in recent years. Whereas the first “biological” attacks, in medieval times, involved hurling dead and rotting corpses over city walls, the attacks through the U.S. mail in 2001 involved anthrax so refined that merely opening an envelope dispersed particles that could infect people nearby and contaminate entire buildings.

In the first documented cases of biological most infamous and experienced army unit, used In the first warfare in the 1340s, Europeans catapulted dead agents such as anthrax, cholera and plague on the documented cases bodies into besieged cities and castles in the hope of Chinese people, beginning in occupied Manchuria causing unlivable conditions and spreading before the war. Members of Unit 731 exposed of biological infections such as plague. By the 1420s, they had hundreds of thousands of civilians to various agents added animal manure to increase infections caused by methods such as contaminating food and warfare in the by the rotting cadavers. One of the more notorious drinking water and dropping bags of plague- 1340s, Europeans reports is that a British commander, Lord Geoffrey infected fleas over cities from airplanes. After the Amherst, in 1763 ordered that smallpox- war, the leaders of Unit 731 agreed to give United catapulted dead contaminated blankets be distributed among States Forces the collection of data they had accrued bodies into American Indian tribes to cause an epidemic, thus from their experiments in exchange for immunity helping British forces to advance through Indian from prosecution for war crimes. In lawsuits for besieged cities territory.Whether such a plan was carried out or reparations, China has said that as many as 50,000 and castles in the succeeded has not been conclusively substantiated; deaths from plague can be attributed to the Japanese however, American Indian populations did suffer attacks, since plague had been unknown in the area hope of causing many epidemics of smallpox in the eighteenth and before then. Officially, Japan has not acknowledged unlivable nineteenth centuries. the attacks. By World War I,the biological sciences had greatly Despite the increasing sophistication of biological conditions and advanced, and the Germans tried to inject livestock warfare programs in the United States, Great Britain, in a number of allied countries with anthrax and the Soviet Union and other countries, there have spreading glanders (a disease that mostly affects horses but, been few instances of any nation ever actually infections such as like anthrax, has also been developed as a biological waging biological warfare. Since the Japanese attacks weapon against humans). The effects of this secret in World War II, the best known cases were the plague. campaign were minimal. By World War II, many reported use of biological weapons in the 1980s and countries were on their way to sophisticated 1990s by Iraq in attacks against Iran, where biological weapons programs. Japan’s Unit 731, the intelligence reports indicated evidence of both

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anthrax and mycotoxins (toxic chemicals produced ill. Another suspicious event occurred in 1996, when by fungi). The weapons also may have been used 12 laboratory workers at a large Dallas medical against Iraq’s Kurdish population. The Soviet center became ill with Shigella dysenteriea (shi- program—undoubtedly the largest development GELL-a dis-in-TER-i-a), which can cause severe effort on biological weapons ever carried out by any diarrhea, after eating contaminated pastries left in a In the latter half nation—made some infamous mistakes, such as an break room. The source of the bacterial strain used accidental release of anthrax in the city of Sverdlovsk was found to be within the medical center itself, of the 20th in 1979, but it conducted no deliberate attacks. suggesting deliberate contamination by a century, the only In addition, both Rhodesia and South Africa did disgruntled employee, but the culprit was never extensive work on developing or acquiring identified. event confirmed biological weapons during the last years of their One case that raised initial suspicions of as a successful respective white-minority governments, and are bioterrorism, but was later ruled out, occurred in believed to have made at least some use of these New Hampshire in 1999 when a woman came down act of weapons against their own black-majority with what appeared to be brucellosis, a rare disease bioterrorism… populations. In Rhodesia, according to Peter Stiff, a considered to be a possible biological weapon. Lab former police officer there who has written books on flasks containing unknown liquids, belonging to a was the one the subject, perhaps as many as “a couple of foreign ex-boyfriend, added to the suspicions. But thousand” black citizens were killed with biological later tests proved that the patient, who died of an carried out by the weapons. unspecified disease, did not have brucellosis, and the followers of In the latter half of the 20th century, the only flasks did not contain biological agents. event confirmed as a successful act of Some other attempts at bioterrorism are known Baghwan Shree bioterrorism—that is, a use of biological weapons to have failed. Before the Aum Shinrikyo cult Rajneesh. by individuals rather than a nation—was the one resorted to spraying the nerve gas Sarin in the Tokyo carried out by the followers of Baghwan Shree subway in 1995, the group had tried numerous Rajneesh, who deliberately contaminated Oregon times to release anthrax and botulinum toxin. The salad bars with salmonella bacteria in 1984 in an attempts failed probably because the cult’s scientists attempt to manipulate local election results. could not refine the agents into a viable form Although nobody died, about 1,000 people became capable of remaining infectious long enough. This

Highlights of Biological Warfare and Terrorism

Europeans throw British allegedly Germans rotting and send blankets attempt to plague-infected contaminated infect allied cadavers over with smallpox to livestock with city and castle Delaware anthrax and walls. indians. glanders.

1340s 1763 World War I

12 A JOURNALIST’S GUIDE TO COVERING BIOTERRORISM failure is encouraging because it attests to the relative the situation beyond the fact that five lives were lost. difficulty of producing and disseminating a (This is less than one-twentieth the number of biological agent in a way that actually harms people, people who die in U.S. car accidents every day.) The despite the group’s strong scientific base, ample public fears and confusion following the attacks— funds and obvious determination to cause about how widespread the infection could become, widespread damage. how reliably it could be diagnosed, and the The anthrax As difficult as it may be to carry out a biological likelihood of fatality from different forms of attack, the anthrax attacks through the U.S. mail in infection—affected the nation’s sense of security for attacks were the October 2001 demonstrated that, with access to a months. However, it also helped to demonstrate that first terrorist highly refined agent, a damaging bioterror attack even with a sophisticated, highly-purified and can be delivered with only an envelope and a stamp. weaponized biological agent, reasonable precautions biological attacks The anthrax attacks were the first terrorist biological such as the rapid sealing and decontamination of to garner attacks to garner immediate worldwide attention. affected buildings, along with a bit of luck, can While the investigation continues and many greatly limit the number of fatalities. (One example immediate questions remain, it is known that the anthrax used of good luck in that case: One of the anthrax letters worldwide was highly refined, highly lethal and probably was found to have become wet somewhere along the originated in a sophisticated laboratory, most likely way, causing the anthrax spores to form clumps and attention. a U.S. government lab. This attack brought a greatly reducing the amount that dispersed in number of issues to the forefront of the nation’s aerosol form when the envelope was opened). consciousness: The United States’ (and the world’s) Another failed attempt was the ricin attack on a vulnerability and lack of preparedness; the relative U.S. Senate office building in January 2004. ease with which a single person or a small group Although powder found in an envelope mailed to a might wreak havoc on a national level; and, most Senator’s office was confirmed through testing as important, shortcomings in how the government, being highly toxic ricin, and additional ricin was also the medical community and the media informed found in other offices, quick action to seal and the public about the attacks and their aftermath. decontaminate the building prevented any casualties Those factors, combined with the media’s from that incident. Once again, this demonstrates inexperience in covering biological attacks, inflamed just how difficult it is for an attacker to produce

Japan’s Unit 731 Five die, eleven Aum Shinrikyo experiments infected by fails in attempts with biological anthrax attacks to release weapons on carried out anthrax and hundreds of through the botulinum toxin thousands of United States in Tokyo. Chinese people. mail.

World War II 1993-1995 2001

13 A JOURNALIST’S GUIDE TO COVERING BIOTERRORISM injuries or deaths by means of a biological epidemic or a deliberate act of terrorism. weapon. But another recent event has Overall, there has been no increase in the underscored the uncertainties that can number of actual attempts to use biological accompany a possible biological attack. When the weapons since the initial anthrax attacks in new disease now known as SARS (Severe Acute October 2001, but there was a huge increase in the Respiratory Syndrome) was first detected early in number of hoaxes, including numerous incidents 2003, there were some initial fears that it might be in which letters were said to contain anthrax but a biological toxin being deliberately spread were actually found by testing to contain through the world’s population. It took several innocuous materials such as talc. In 2001 there weeks of study to determine its natural origins were 600 such hoaxes, according to a survey by the and pattern of spread, apparently from initial Center for Nonproliferation Studies in Monterey, infections in Southeast Asia, and to identify the Calif., but only seven cases where actual infectious virus responsible. But it is entirely possible that agents were found. The vast majority of the hoaxes some future attack could unfold in a similar way, (550 of them) involved attempts to intimidate leaving people—including doctors and public- abortion clinics. In 2002, the latest year for which health officials—uncertain for an extended figures were available, there were 70 hoaxes, and period about whether they were facing a natural no real agents were found.

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How a Biological Attack Might Unfold

The method used to carry out a biological attack will play a large part in how many people are infected and with what type of infection (e.g., pulmonary anthrax vs. cutaneous anthrax, discussed further in a later chapter).

Dissemination methods could range from using adhesive forces; a glass container filled with such a humans as “biological bombs” by sending infected, refined powder, broken on subway tracks, would contagious individuals into crowded, confined generate a “secondary” aerosol by stirring up the places, to dropping fleas from airplanes. However, powder into the air. The powdered anthrax sent the scenarios discussed below are presently through the mail worked this way; the action of considered more likely than others due to their opening the envelope stirred up the powder into a relative ease and effectiveness. secondary aerosol. Agents disseminated outdoors would have to be Aerosol Dissemination hardy so as not to degrade too quickly due to Aerosol dissemination is considered by many sunlight, heat, cold or wind. An open-air attack analysts to be the likeliest route for dispersing most would be most devastating if it occurred during a Aerosol of the biological agents considered threatening meteorological condition known as inversion, the dissemination is today. Given the idealized case of “correct” familiar condition often responsible for smoggy technology, agent, environment and target, such an summertime days when a layer of colder air acts as a considered by attack could infect hundreds of thousands, or even cap, holding down a layer of warmer air at ground many analysts to millions, of people. For example, a U.S. level, and thus preventing the vertical dissipation of Congressional Office of Technology Assessment pollutants—or an aerosolized biological agent. be the likeliest study concluded that 220 pounds (100 kilograms) of However, an attack’s “success,” in the terrorists’ anthrax, thoroughly distributed in aerosol form over eyes, need not be measured only in terms of route for a large city, could kill as many as three million casualties. Even if terrorists used a relatively dispersing most people. inappropriate aerosol, such as one that degraded This method involves dispersing an agent in a quickly due to exposure to sunlight, even a handful of the biological particulate form sized to effectively travel through of actual victims might lead to nationwide panic agents considered the air, lodge in human lungs, and cause infection. and fear, as exemplified in the wake of the anthrax Aerosols could be distributed by planes or trucks attacks though the U.S. mail. threatening equipped with sprayers, by stationary sprayers in today. high places such as the roofs of buildings, or by Human Carrier sprayers in confined spaces such as buildings or Novels and movies often have portrayed an subway systems. Aerosols also can be generated infected person wandering about, purposely when specially refined powders overcome normal infecting others with bacteria or a virus. This

15 A JOURNALIST’S GUIDE TO COVERING BIOTERRORISM

method has at least one clear advantage: The agent an individual building’s or small area’s water supply need not be highly refined because the terrorists may be a likelier threat. Even on a smaller scale, the need to infect only one individual directly. agent must be able to overcome factors such as Moreover, this method is relatively inexpensive and dilution and chlorination. requires no difficult equipment to disseminate the Deliberate mass contamination of food may be Mass water agent. If a highly contagious agent were chosen, and less difficult to accomplish than mass contamination the infected individual able to expose a significant of water. Food can be contaminated at any step in supplies are less number of people without attracting attention, the processing—from manufacturing to packaging to vulnerable than attack could lead to widespread illness, and even distribution and sales. While this method of wider panic. distribution would most likely not infect as many individual water However, the human-as-biological-bomb people as a worst-case aerosol release would, a supplies; method is not practical in many ways. First, it handful of infections in an isolated area could cause would work only with contagious agents, and the nationwide fear of infection, mass recall of products, municipal water agents considered likeliest for a biological attack and a significant effect on the economy. Again, the supplies are more would make their victims so ill, and so quickly, agent and method of contamination would have to that by the time they were contagious (for avoid degradation by chemicals or temperature difficult to access example, with smallpox) in many cases they extremes involved in processing or distribution. wouldn’t be able to get out of bed, much less Other scenarios for distribution are possible, such and contaminate wander a mall or subway station. Even if they as dermal (skin) exposure (botulinum toxin and than widely could wander around a populated place, in most anthrax could be spread this way) and insect-borne cases they would be visibly ill, have a rash and transmission of an illness, but due to technical believed. most likely attract attention, sparking an early difficulties and lower possibilities of success, they are response effort. While this method would be less likely to cause widespread illness than the inexpensive and low-tech (except, of course, for methods described above. the difficulty of obtaining the necessary infectious agent in the first place), it also would require How a Bioterrorism Event someone willing to become infected (or able to be Might Unfold duped), as well as a certain amount of luck, to Every event is likely to be different. As discussed infect others without being noticed. already, the sheer number of factors involved in a possible bioterror attack gives any “master scenario” Oral Ingestion limited usefulness. The different methods of The final scenario that is considered a likely threat distribution, the array of agents, and other factors involves deliberate contamination of food or water such as environment, population density and supplies. Mass water supplies are less vulnerable population vulnerability yield a near infinite range than individual water supplies; municipal water of possible scenarios. To illustrate some of the basic supplies are more difficult to access and stages of such a possible attack, however, a general contaminate than widely believed. The dilution scenario is described below. caused by the large volume of water in a public Unless the dissemination of the agent is supply, diffusion far from the initial point of noticeable or the perpetrators issue some kind of contamination, and chlorination that can kill most warning (which they might do, for example, to human disease-causing organisms, make the maximize the public’s initial fears), a biological infliction of mass casualties by this method highly attack probably will go undetected until sometime unlikely. However, because even a few infections, as after the first victims begin to show symptoms. The noted earlier, could produce serious social, incubation periods of infections vary greatly but psychological or economic harm, contamination of generally range from a few days to two weeks. The

16 A JOURNALIST’S GUIDE TO COVERING BIOTERRORISM old, the immuno-compromised and the very young dispel rumors and expose profiteers who may seize will be the first to fall ill. Most biological infections on public fears to sell “snake oil” remedies. For first manifest with symptoms similar to those of the example, rumors circulated in 2001 that mail flu such as aches, fever, nausea and fatigue, making a suspected of being contaminated with anthrax correct first diagnosis unlikely. could be sterilized and rendered harmless by passing Health care professionals will suspect something a hot iron over it—something most public-health Most biological out of the ordinary either when they notice an experts considered a useless precaution. And some unusually large number of similar diagnoses or people tried to take advantage of public fears by infections first when the illness progresses in certain individuals in selling useless devices, such as portable ultraviolet manifest with ways inconsistent with common illnesses. The lights supposedly capable of sterilizing surfaces or vigilance of health care professionals will be a critical objects in a few seconds, or gas masks that most symptoms similar factor in the early detection of a bioterror attack. specialists say are virtually worthless for biological to those of the Whether the attack involves food poisoning or an attacks. On the other hand, media can call people’s aerosol release of smallpox, doctors, nurses and attention to simple and often inexpensive measures flu such as aches, emergency medical personnel will form the first line they can take to protect themselves against some fever, nausea and of awareness. Early detection has the potential to kinds of infectious diseases, such as frequent greatly mitigate the effects of an attack—whether by handwashing and the use of simple paper or cloth fatigue, making a allowing for the isolation of the source of infection, surgical-type masks when going to crowded areas. as in the case of deliberate food poisoning, or by The progression of a bioterror scenario depends correct first allowing vaccinations to begin, as in the case of a largely on the type of agent used (for example, diagnosis smallpox outbreak. short-acting toxin vs. contagious virus) and the Detection of an unusual occurrence or group of method of dissemination (such as local food unlikely. symptoms will start several different chains of contamination vs. aerosol release over a large city). response. Epidemiologists will attempt to trace the The breadth and severity of infection will determine path of infections toward a single person or location, the steps taken on local, state and federal levels. The laboratory scientists will work to identify the specific response might require no more than treating a agent, health care workers will care for the ill, and handful of infected individuals, but at worst it could government health officials will decide how best to involve months of antibiotic treatments, decisions contain the infection and mitigate its effects. about how widespread vaccination rounds should Once the outbreak is reported to the public, be, isolation policies or even quarantines. how various media outlets handle the reporting of Given the myriad possibilities for a biological the unfolding story can make a big difference in attack, preparation never will be complete because the course of the outbreak and the success of new threats emerge, technology develops and the efforts to contain and treat it. News organizations, population and its vulnerabilities change. striving to get the most accurate and helpful Hypothetical scenarios may help us to examine information possible out to the public in a way possibilities and test certain aspects of response that may contribute toward keeping people alive, plans, but they also can be dangerous if relied on to certainly can play a crucial role in helping to encompass all possible events. mitigate the effects of an attack. And one major Whether the next terror attack against the United factor in helping that process is to know ahead of States involves chemical, biological or nuclear time whom to call for informed and reliable weapons, conventional weapons like bombs or guns, comment. or once-unthinkable weapons such as commercial Another useful service the media can provide airliners, we have learned that uncharted areas of during such an attack—as many did during the terrorism might remain for which no scenario can 2001 anthrax attacks—is to quickly check out and prepare us.

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Possible Bioweapons

The idea of using biological agents as weapons both fascinates and terrifies the public and nothing grabs attention more than the names of agents themselves: anthrax, smallpox, Ebola. Despite their fascination, the public knows little about the specifics of biological agents.

Good coverage of bioterror in general must be needed to refine the bacterium to reduce it to its informed, and a clear, sophisticated, straightforward most infective size and to decrease electrostatic discussion of the specific agents is especially critical. clumping, enabling it to travel long distances in the To dispel misinformation and clearly delineate the air and be inhaled. Once weaponized, anthrax is main issues surrounding bioterrorism, this chapter easily disseminated, as demonstrated by the attacks covers important facts about the six agents the of October 2001, and by the Sverdlovsk accident in Centers for Disease Control and Prevention calls 1979, which resulted in human fatalities as far as Category A agents—those deemed to pose the highest four kilometers away from the release site. However, threat—as well as others, listed in categories B and C, anthrax is not contagious; only those directly that it has identified as lesser but possible risks. This exposed can develop infection. Good coverage of chapter also covers additional agents that have been bioterror in identified by the World Health Organization, the U.S. Infection and Treatment military and other sources, as well as some that have Although all forms of anthrax are caused by the general must be in fact been developed and perhaps even used as same bacteria, the effects are very different informed, and a weapons (Iraq’s development and alleged use of depending on how the organism enters the body. aflatoxin weapons falls into this category). Inhalational or pulmonary anthrax, which affects clear, the respiratory system, is the most lethal form of sophisticated, exposure to the disease and is therefore currently Anthrax believed to be the form most likely used in a terrorist straightforward Short Description attack. Once inhaled, the tiny anthrax spores (one to discussion of the Bacillus anthracis (ba-SILL-us an-THRA-siss) is a five microns in size, less than one-twentieth the rod-shaped bacterium that infects humans through diameter of a human hair), enter the lungs’ alveoli, specific agents is the respiratory system, the skin or the digestive or air sacs, where blood is oxygenated. Authorities system. As bacteria go, anthrax is hardy (it can originally believed that at least 10,000 spores were especially critical. remain in a dormant spore form for decades before needed to infect a human being, but the October becoming active again), widely available (it is 2001 attacks suggest that much smaller amounts— researched at more than 2,000 laboratories in the perhaps just a few thousand—might be enough to United States alone), and, depending on the method cause infection. From the lungs, the infection of infection, highly lethal. Anthrax is not easy to spreads to the lymph nodes in the chest, and within disseminate. Sophisticated processes—collectively hours or days, the bacteria begin producing large known as the weaponization of anthrax—are amounts of a deadly toxin.

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Anthrax infection progresses in two phases, the develop from these sores, but cutaneous anthrax first of which brings flu-like symptoms including is eminently treatable with antibiotics. fever, nausea, vomiting, aches and fatigue. As with Naturally occurring gastrointestinal anthrax most other biological agents, these symptoms are results from ingestion of meat contaminated with nonspecific and often resemble the flu so that the anthrax bacteria; symptoms usually occur within initial diagnosis is likely to be incorrect. Health two to five days and include stomach pain, The first care workers will have to be extremely vigilant to diarrhea, fever and septicemia (bacteria in the notice a sharp rise in similar cases or in slightly blood). Untreated, gastrointestinal anthrax will symptoms of unusual symptoms. The first symptoms usually kill about 50 percent of patients, but antibiotic anthrax usually appear in one to seven days after exposure but in treatment can greatly reduce this fatality rate. some cases can appear more than a month later. A appear in one to short recovery-like period sometimes follows the Prevalence seven days after first phase, but the infection progresses to its final Anthrax is widely available. The bacterium phase within two to four days of the onset of occurs naturally in domestic livestock and certain exposure but in symptoms. The second set of symptoms is wildlife, and is currently legally studied at more some cases can characterized by respiratory distress and failure, than 2,000 facilities in the United States alone. shock and sometimes death. Untreated The sheer number of people with access to these appear more than inhalational anthrax has a fatality rate of facilities greatly increases the likelihood that approximately 90 percent. Aggressive long-term access privileges could be abused for sinister a month later. treatment with antibiotics may reduce the fatality purposes, either by carrying out an attack rate to 30 percent. themselves or by selling anthrax. The Antibiotic treatment is most successful if begun sophistication and specific strain of the anthrax before the toxin is released, which can occur used in the attacks through the U.S. mail in 2001 anywhere from hours to days after exposure. An suggest that it originated in a laboratory. Until anthrax vaccine exists, but it is not a treatment relatively recently, strains of anthrax were option; it is effective only if the first of six available through the mail for research. It is not inoculations is given at least four weeks before known if any such samples were shipped to exposure. The vaccine is presently given only to people with illegal or terrorist intents. However, those considered to be at a heightened risk of records recently scrutinized by Congress show exposure, including lab workers and certain that the U.S. government allowed the CDC and a members of the armed forces. It consists of three biological sample company to export strains of injections given two weeks apart, followed by three anthrax and other deadly biological agents to more injections at six, 12 and 18 months. Annual Iraqi sites during the 1980s. booster injections are recommended to maintain immunity. Summary While cutaneous and gastrointestinal anthrax Alternate Forms of Exposure produce severe symptoms and can be fatal, neither Anthrax also can infect humans through the approaches the lethality of inhalational anthrax as skin (the cutaneous form) or through the a bioweapon. Inhalational anthrax is a dangerous digestive system (the intestinal form). Cutaneous weapon due to its stability in the environment, its anthrax infections occur when open wounds or widespread availability, and its high lethality. Its cuts come in contact with the anthrax bacterium. usefulness to terrorists is compromised only by the The resulting infection appears one to seven days degree of skill and equipment needed to make it a after exposure and is characterized by sores that viable weapon and by the fact that it is not progress to black scabs. Systemic infections may contagious.

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Botulinum Toxin Treatment Short Description A commercially available antitoxin can halt the spread of paralysis caused by botulinum toxin, Botulinum toxin is produced by the bacterium but it must be administered soon after the onset Clostridium botulinum (clos-TRI-dee-um bah- of symptoms. It would not reverse paralysis that tchoo-LINE-um) and is the most poisonous Botulinum toxin already has occurred. Further treatment such as substance known to man. The toxin produces a respiratory support may be required to sustain could be descending paralysis known as botulism, which is life, depending on the degree of paralysis. most often traced to the consumption of Paralysis will generally diminish with time. employed as a improperly canned or undercooked food tainted A vaccine exists but is presently used only for with the bacterium. Botulinum toxin could be bioweapon via laboratory workers and troops deployed to high- employed as a bioweapon via aerosol dissemination risk areas. The vaccine is in short supply and is aerosol or the intentional contamination of food or drinks. very painful to receive. It also is not effective The latter is considered the likeliest method for a dissemination or against all forms of the toxin. These factors, plus bioterror attack because it is the easiest to carry out, the current usage of botulinum toxin to treat the intentional requires the least amount of bioengineering, and certain medical conditions, make mass maintains the toxicity of the agent. Botulism is not contamination of vaccination impractical and unlikely. contagious; only those who ingest or inhale the food or drinks. toxin become ill. Alternate Forms Infection Botulism can occur in humans in two Botulinum toxin can cause disease in humans additional forms not relevant to bioterror. via four different routes, only two of which are Infantile botulism occurs when children less than relevant to bioterror: ingestion and inhalation. If one year old ingest large amounts of the spore botulinum toxin is ingested through contaminated form of the Clostridium botulinum (not harmful food or drink, it affects nerve transmission, to older children and adults). Wound-type resulting in muscle paralysis. In the case of food- botulism is extremely rare and occurs when an borne botulism, the first symptoms of this open wound comes into contact with Clostridium paralysis usually appear within 12 to 36 hours after botulinum. Wound-type botulism progresses ingestion and include double vision, drooping similarly to the ingestional form. eyelids, dry mouth and difficulty swallowing and talking. Paralysis then spreads from the face Prevalence and neck in a descending fashion to the rest of Clostridium botulinum occurs naturally in soil, the body, eventually paralyzing respiratory and thus it is widely available. While this is a good muscles and often leading to death from source of toxin suitable for contaminating food or respiratory failure. About 60 percent of those drink, the toxin must be highly refined to with untreated ingestional botulism will die. function efficiently as an aerosol. The Japanese Botulinum toxin also can be inhaled, but this cult Aum Shinrikyo failed to produce an effective second possible method of bioterror attack is aerosol form of botulinum toxin despite considered less likely because it would be more significant funding and scientific expertise. The difficult to carry out and could be less effective. Soviets devoted significant attention to Botulinum toxin is unstable in the environment, developing botulinum toxin as a bioweapon, and and a high degree of technical expertise would be the stores of toxin and the scientists who necessary to render it suitable for aerosol release. produced them are unaccounted for.

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Summary thought to pose the greatest risk for a bioterror The high toxicity of botulinum toxin, its wide attack because it infects people more easily than availability and the probable need for long-term the other forms and also is the only form that is medical care for infected persons make it an effective contagious. Pneumonic plague results from the bioweapon. The progressive paralysis of botulism is inhalation of the bacteria into the lungs or from a particularly dramatic symptom that would make the spread of infection of the septicemic form. noninflammatory media coverage even more Once inhaled into the lungs, symptoms usually difficult; this paralysis joins the disfiguring blisters of appear after two to four days and include a cough- smallpox as symptoms that pose a particular risk of producing bloody mucus, fatigue, fever, diarrhea, causing a disproportionate amount of fear in those nausea and vomiting. The infection can pass from watching television media coverage or reading an infected individual to others by coughing. A written accounts. full pulmonary infection follows the initial symptoms, and death can follow within a day or two if the infection is not treated early and Plague aggressively. Short Description Plague is the disease caused by infection with the Treatment rod-shaped bacterium Yersinia pestis (yur-SIN-ee-a Successful treatment of pneumonic plague PESS-tiss). Plague does not receive as much public requires antibiotics within 24 hours of exposure. attention as anthrax or smallpox, but its lethality, The immediacy of the need for treatment would contagiousness and infectivity make it one of the make a large-scale response effort especially most deadly and potentially effective bioweapons. difficult to coordinate; while individuals exposed Pneumonic plague (deemed the most likely form of to smallpox must be vaccinated within four days plague to be used in a bioterror attack) has a lethality of exposure, those with plague have only hours to rate of almost 100 percent if left untreated and receive treatment. No accepted plague vaccine approximately 50 percent if treated—high enough exists today. However, a vaccine developed at to make overcoming the difficulty of acquisition, Porton Down defense research laboratory in refinement and dissemination well worth a England has passed initial safety tests and as of terrorist’s while. February 2004 was expected to be made available for widespread use within one to two years. Infection Plague is naturally transmitted to humans Alternate Forms of Infection either by inhalation or by the bite of a flea that has The bubonic form of plague occurs when an previously bitten a rodent infected with the infected flea bites an individual. Instead of infecting bacterium. In the case of a bioterror attack, the the lungs, as in the pneumonic form, bubonic bacterium might be released in an aerosolized plague infects the lymphatic system. The first form into the air. Refining the bacteria to an symptoms, including weakness, fever and chills, effective, airborne form that can cause generally appear two to eight days after exposure. pneumonic plague requires a high degree of These initial symptoms are followed two to four technical expertise. Moreover, plague is not days later with the characteristic and painful extremely stable; it degrades in sunlight or heat swelling of the lymph nodes (called buboes). but can remain viable for up to a year in the soil. Untreated, death can follow within a few days. Plague infection in humans can take three Bubonic plague is not contagious. forms: pneumonic, bubonic and septicemic. As Septicemic plague can occur when the plague previously mentioned, pneumonic plague is infection enters the bloodstream, leading to internal

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hemorrhaging and, without prompt treatment, to-face contact and falling somewhere between rapid death. Septicemic plague is not contagious. tuberculosis and chickenpox in the spectrum of contagiousness. Smallpox is lethal in approximately Prevalence 30 percent of cases, and a concerted, decades-long About 1,500 plague infections occur naturally program based on simple public health measures, Smallpox each year in the world. While most of these containment and targeted vaccination resulted in its infections are of the bubonic type, outbreaks of control and eventual eradication. The last naturally contagiousness pneumonic plague could become epidemics and occurring case was in Somalia in 1977. As described begins only with breed public panic. Laboratories around the world in Richard Preston’s 2002 book “The Demon in the study plague bacteria, and while these samples are Freezer,”smallpox is the potential biological weapon the appearance of protected, there are no assurances that these that many specialists fear most. a rash, generally safeguards are 100 percent effective. Plague was among the biowarfare agents most intensely studied Infection two to three days and most massively produced by the Soviet The variola virus that causes smallpox belongs to biowarfare program. Hundreds of tons of the the orthopox virus family. Infection is caused by the after the onset of bacterium were produced, and similar to fears inhalation of small fluid droplets, called aerosols, or the initial concerning smallpox, the fate of these stockpiles by direct contact with lesions or contaminated remains unknown, as do the present locations of objects. Smallpox has an incubation period of seven symptoms. many of the scientists who worked on developing to 17 days, with the first symptoms usually plague as a weapon. appearing 12 to 14 days after exposure. The first symptoms include high fever, backache, headache, Summary fatigue and physical collapse. These symptoms, While some biowarfare agents garner more media particularly extreme physical exhaustion and and public attention than they warrant (e.g., prostration, serve to reduce the virus’s transmission smallpox and Ebola), plague has received perhaps rate.There is a common misunderstanding that less attention than it is due. With its high infectivity, people infected with smallpox will be mobile in the high contagiousness and high fatality rates, plague’s population while they are contagious. In fact, by the serious threat status as a bioweapon is diminished time infected people become contagious, they have only by its instability in the environment and the usually been experiencing severe physical degree of technical sophistication required to refine exhaustion and aches for several days and are it and disseminate it effectively. unlikely to be out of bed, much less going to work, running errands or visiting heavily populated areas. Contagiousness begins only with the appearance Smallpox of a rash, generally two to three days after the onset Short Description of the initial symptoms. The rash starts as small pink Smallpox, or Variola (va-ree-OH-la), is among dots in the mouth and throat and spreads to the face the few contagious bioterror agents, and its and arms, then to the trunk and legs. The dots symptoms are particularly severe and permanently progress to form lesions, filling with pus and disfiguring. Through recorded history, it has killed becoming painful. Within eight or nine days of the hundreds of millions of people. These factors make onset of the rash, scabs begin to form over the it a particularly fearsome agent and therefore prone lesions, eventually falling off approximately 14 days to inaccurate or exaggerated perceptions. However, after the first onset of symptoms. Victims remain smallpox may not be as effective a bioweapon as contagious until all the scabs have fallen off, and the many believe. First of all, it is not as contagious as scabs usually leave disfiguring scars. some reports have suggested, requiring direct face- Two other known manifestations of smallpox

22 A JOURNALIST’S GUIDE TO COVERING BIOTERRORISM infection are historically rare but generally fatal: ordered production of enough smallpox vaccine to Purpura variolosa, or hemorrhagic-type smallpox, vaccinate the entire U.S. population, should the which involves a severe loss of blood into the skin decision be made to do so. At this writing, such mass and internal organs; and flat-type smallpox, vaccination has not been ordered and a more characterized by slow-developing lesions that targeted approach, aimed at front-line medical, law remain soft to the touch and never rise above the enforcement and emergency personnel is After the anthrax surface of the skin. These variations generally considered more prudent. develop in 3 percent and 5 percent, respectively, of In fact, a study published in Science in November attacks in 2001, persons infected with variola major. Variola minor, a 2002 showed that as long as there are some members the U.S. variation of the smallpox virus, is less severe than the of the population who have immunity (from typical variola major strain, killing approximately 1 childhood vaccinations or from a targeted government percent of those infected. vaccination program aimed at first-line responders), ordered a targeted approach focused on areas where cases Treatment have been reported is more effective than mass production of No definitive treatment exists for smallpox, but vaccination at curbing an outbreak. enough smallpox vaccination within four days of infection can prevent or mitigate the effects of the disease. The Prevalence vaccine to smallpox vaccine consists of live vaccinia virus and Ironically, smallpox was supposed to be the one has the highest rate of adverse effects of any scourge the world did not have to worry about any vaccinate the commonly used vaccine. more. In 1980, the World Health Organization entire U.S. Experience with vaccination in the 1960s suggests declared smallpox eradicated, with the last naturally that if the entire U.S. population were vaccinated, acquired case occurring in Somalia in 1977. After population approximately 1,500 would suffer severe side effects 1980, samples of the virus were supposed to be and approximately 300 would die. These stored in only two locations: at the CDC facilities in estimations do not take into account the fact that Atlanta and at a Russian laboratory known as Vector, compared with the U.S. population in the 1960s, a in the town of Koltsovo near Novosibirsk. However, much larger percentage of today’s population is the defection of high-level Soviet biowarfare immuno-compromised and therefore more scientists in the early 1990s brought the massive susceptible to complications from the vaccine. Soviet biowarfare program to light and revealed that Because the vaccine contains live vaccinia virus, it it had produced and tested massive amounts of the can cause disease, especially in persons with virus—a stockpile of 20 tons of weaponized compromised immunity. It also can, on rare smallpox was maintained as late as the 1980s for occasions, be transmitted from person to person. immediate use by the Soviet military. The program’s HIV/AIDS, past radiation or chemotherapy smallpox and other biowarfare agents have been treatment, past transplant surgery and even a unaccounted for—increasing concerns that nations history of eczema all are conditions that increase the that sponsor terrorism, or sophisticated likelihood of severe side effects or death from the transnational groups, such as al Qaeda, could have vaccine. A treatment called vaccinia immune made attractive offers to former Soviet biowarfare globulin (VIG) can mitigate most severe reactions to scientists looking to escape desperate circumstances vaccinia, and the antiviral medication Cidofovir in the former USSR. Thus, there is no definitive may be effective in treating certain adverse reactions. information on the amount of smallpox at large in Development of a safer vaccine is a high research the world today. As of November 2002, intelligence priority, but the vaccinia vaccine remains the only reports indicated that four nations harbor available method to prevent infection. After the unauthorized stocks of the virus: Iraq, North Korea, anthrax attacks in 2001, the U.S. government France and Russia (which also has one of the two

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known authorized stocks).While Iraq no longer expertise is required to cultivate the bacterium in a possesses such stocks, the other three nations are still form allowing efficient dissemination. However, believed to have supplies of the virus. because of tularemia’s extremely high infectivity, if it is refined and disseminated efficiently, a small Summary amount of agent could infect a very large number Tularemia While smallpox is a fatal contagious disease that of people. may presently be in terrorist hands, it is not as The incubation period for inhalational infection can contagious as commonly feared, and terrorists with tularemia is usually three to five days, but it can be manifest in a designs to use smallpox in a bioterror attack would as short as one day or as long as two weeks. Initial encounter some serious obstacles, including symptoms include sudden fever, chills, coughing, variety of forms, accidental infection, difficulty in dissemination and joint pain, headaches and general weakness. depending on the blowback (the spread of infection to those originally Clinicians will, in all likelihood, have a difficult disseminating a contagious agent). time identifying tularemia if an attack occurs route of infection because these symptoms are common and not and the virulence easily or immediately differentiated from those of Tularemia influenza or even the common cold. The of the particular Short Description inhalational form of tularemia can progress Tularemia, also known as rabbit fever and deer fly quickly to full-blown pneumonia, with symptoms strain of the fever, is caused by the Francisella tularensis (fran-sis- including shortness of breath, a cough producing bacterium. SELL-ah too-la-REN-sis) bacterium. While neither bloody mucus, and chest pain. In the absence of is easy to disseminate nor particularly lethal, treatment, the mortality of inhalational tularemia tularemia is one of the most infectious diseases may be as high as 60 percent; prompt antibiotic known, making it a serious risk as a bioweapon. treatment, however, reduces the fatality rate Whereas someone must inhale at least several significantly. thousand anthrax bacteria to become infected, Of those infected with tularemia through inhalation of a single tularemia bacterium is inhalation, a small percentage will develop sufficient to cause infection. Tularemia is unstable in typhoidal, or septicemic, tularemia instead of the environment and particularly susceptible to pneumonia. This infection is concentrated in the heat, but it can remain stable for months in moist circulatory system instead of just in the respiratory soil; advanced processes are necessary to stabilize the system and may also lead to death if not treated bacterium for effective dissemination. However, with antibiotics. Typhoidal tularemia presents a tularemia is not contagious and is eminently diagnostic challenge because, unlike the treatable with antibiotics, so even if many people pneumonic form, it is not detectable by x-ray, and became infected, a quick diagnosis and a rapid it is characterized only by fever, extreme response could significantly mitigate the effects of exhaustion and weight loss. The fatality rate of an attack. typhoidal tularemia may approach 35 percent in untreated cases. Infection and Treatment A tularemia vaccine exists and was formerly Tularemia infection can manifest in a variety of administered only to individuals who work with forms, depending on the route of infection and the the bacterium in laboratories, but it is no longer in virulence of the particular strain of the bacterium. use. The vaccine took about two weeks to provide A bioterror attack would be most dangerous in the protection and was not entirely effective against the case of an aerosol release, causing severe inhaled form of tularemia; therefore, it is not pneumonia in those exposed. As with many other considered to be worth using either before or after biological agents, a significant degree of technical a biowarfare attack. Another vaccine that should

24 A JOURNALIST’S GUIDE TO COVERING BIOTERRORISM provide better protection against the inhaled form bunyaviruses (e.g., Rift Valley Fever), and of tularemia is under development. flaviviruses (e.g., yellow fever and dengue). All of these viruses can cause severe, life-threatening Alternate Forms illnesses, but mortality rates vary tremendously for The natural ulceroglandular form of tularemia the different agents. All may cause hemorrhagic infection is usually contracted through the bite of an syndromes characterized by severe internal and All viral infected tick or fly, or when infected meat comes external bleeding. Some VHFs are contagious, into direct contact with abraded skin or an open including Ebola, Marburg and Lassa. hemorrhagic wound. Ulceroglandular tularemia is characterized While the Ebola virus gained widespread fevers may cause by the appearance of an ulcer at the infection site notoriety, partly as a result of “The Hot Zone” by and the subsequent swelling of regional lymph Richard Preston and other reports of an outbreak syndromes nodes. Ulceroglandular tularemia has a lower of the disease in a colony of laboratory monkeys characterized by fatality rate than pneumonic or typhoidal tularemia and of human outbreaks in Africa, VHFs generally and is treatable with antibiotics. Tularemia infection are not considered likely to be developed into severe internal can also occur when undercooked, infected meat is highly lethal bioweapons. Many of them and external consumed. incapacitate and kill their victims so efficiently that the virus does not have enough time to infect bleeding. Prevalence others, making containment easier and a Tularemia occurs naturally in rodents, but widespread outbreak much less likely. Even in the isolating and growing the bacterium from natural event of an outbreak, routine infection control sources would require a high degree of expertise. procedures are often adequate to break the cycle of The former Soviet Union, the United States and transmission. However, depending on the Japan all developed tularemia as a bioweapon, with particular virus, the majority of those infected may the Soviet research continuing into the 1990s. As die, and those that do will die in a particularly with many other agents, the mass quantities horrifying manner. produced by the Soviet biowarfare program and the scientists behind the program have not been located. Infection The VHFs are vector-borne diseases, which Summary means they occur naturally in humans only after A very high percentage of those exposed to contact with an infected insect, rodent or larger tularemia would become infected, but it would be mammal. This contact can consist of touching fecal only those individuals directly exposed, as tularemia matter, receiving a direct insect bite, or handling is not contagious. Almost all of those infected can be contaminated meat. However, it is possible that effectively treated with antibiotics. Tularemia is not these viruses could be disseminated in an aerosol highly lethal like anthrax, or highly feared like form in a bioterror attack. The problem lies not in smallpox, but it is highly infectious, making it a producing the virus but in acquiring a sample and sufficiently dangerous bioweapon to pose a refining it to a form suitable for aerosolization. significant threat. These viruses are generally unstable in the environment and do not fare well as aerosols; a high degree of technical sophistication would be Viral Hemorrhagic Fevers necessary to make the virus viable as a weapon. Short Description Symptoms of VHFs vary but generally include Viral hemorrhagic fevers (VHFs) include four high fever, dizziness, muscle aches and exhaustion; distinct families of viruses: filoviruses (e.g., Ebola such nonspecific symptoms make initial diagnosis and Marburg), arenaviruses (e.g., Lassa), difficult. Initial symptoms usually appear anywhere

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from two days to three weeks after exposure. Research on Ebola and other VHFs was performed Individuals with severe cases may display signs of as part of the Soviet Union’s biowarfare program, bleeding (which usually appear approximately five raising the same security issues described above for days after the appearance of initial symptoms). the other agents. Bleeding can occur from internal organs, under Viral hemorrhagic the skin and from the eyes, nose, mouth, ears and Summary other orifices. This bleeding makes for inherently Viral hemorrhagic fevers vary in their potential as fevers vary in frightening photographs and television footage bioweapons, in contagiousness and in fatality rates. their potential as that could lead to panic out of proportion with the One of the main factors to consider in the event of a actual situation. Advanced symptoms of VHFs bioterror attack using a VHF would be the public’s bioweapons, in also can include shock, nervous system fear and panic due to prior exposure to the contagiousness malfunction, seizures and coma. Fatality rates gruesome effects of these viruses (or fictionalized range from as high as 90 percent for Ebola to less viruses based on VHFs) through books and movies and in fatality than 1 percent for the arenavirus Lassa. such as “The Cobra Event” by Richard Preston and rates. the movie “Outbreak.” Treatment Treatments and vaccines exist for some VHFs but not for others. No treatment or vaccine exists Category B Agents for Ebola or Marburg, but supportive therapy The Centers for Disease Control and Prevention may prevent shock and support organ functions defines as Category B those potential biological and anecdotal evidence suggests that advanced weapons that are considered the second-highest intensive care can reduce mortality rates. Isolation priority, because they are moderately easy to and decontamination will be critical in stopping disseminate, cause moderate amounts of disease the spread of these diseases; the use of gowns and and low fatality rates, but may require specific masks, decontamination and disposal of medical public-health action such as improved diagnostic equipment, and education about containment and detection systems. The CDC revises the list can greatly mitigate the effects of an outbreak. periodically. An antiviral drug called ribavirin may treat some VHFs effectively if administered early in the The agents currently listed as Category B are: progression of the disease. A vaccine is available for yellow fever that is regularly given to people Brucellosis (Brucella) (broo-sul-OH-sis, broo- traveling to areas considered to be high-risk for SELL-a) — This toxin is quite potent - it takes the disease. Treatments and vaccines for other fewer than 100 of the Brucellosis bacteria to VHFs, including Ebola, are currently under produce infection. Its lethality rate is low (fewer development. than 5 percent of infected individuals will die), but it is very stable in the environment. Incubation Prevalence period is five to 60 days, and the illness itself can Accessibility to VHFs varies greatly depending on last for weeks to months once symptoms begin. the specific virus; the viruses of greatest concern There is no vaccine. (such as Ebola and Marburg) would be very difficult to acquire from the wild because their natural host Enterotoxin B (produced by Staphylococcus) is unknown and outbreaks are rare. VHFs are (STAFF-ill-oh-CAW-cuss) — This toxin, produced studied in some laboratories, but due to the high by staph bacteria, can cause illness within a few fatality rate and infectivity of these agents, they are hours to six days, but has a very low lethality rate generally studied in high-security laboratories. (less than 1 percent), and illness only lasts a few

26 A JOURNALIST’S GUIDE TO COVERING BIOTERRORISM hours. It is stable in the environment, and can even various species of Shigella bacteria cause 600,000 survive freezing. There is no vaccine. deaths per year, usually through contaminated water or food. Symptoms begin with diarrhea, and Epsilon toxin (produced by Clostridium proceed to seizures and sepsis. No vaccine exists, but perfringens) (claw-STRID-ee-um per-FRINGE-enz) treatment with antibiotics is usually effective with — A common cause of food poisoning, especially most strains. Some drug-resistant strains exist, from improperly cooked beef or chicken. however. E. coli has been responsible for outbreaks of food poisoning from ground beef. Glanders (Burkholderia mallei) (ber-cold-AIR-ee- ah MAL-ee-aye)—This bacterial disease is highly Water safety threats (e.g. Vibrio cholerae, lethal, killing more than 50 percent of those Cryptosporidium parvum)—For example, cholera exposed. Distributed in aerosol form, it produces (caused by the Vibrio cholerae bacterium) is symptoms within 10 to 14 days, and leads to death unstable in the air or fresh water, but remains stable from septicemia (blood infection) within seven to in salt water. It can be transmitted from person to 10 days of the onset of symptoms. It can be person, but this is rare. Its symptoms begin to transmitted from person to person, but at a low rate. appear within four hours to five days (typically, two It is stable in the environment, and there is no to three days). The illness last for a week or more, vaccine. and is highly lethal without treatment, but has a low mortality rate with treatment. Q fever (Coxiella burnetti) (cock-see-ELL-ah ber- NET-ee)—A bacterial disease that can be spread in Other category B agents (see Glossary for aerosol form. It has an incubation period of 14 to 26 definitions): days, can kill within weeks, and is quite stable in the environment once dispersed—it can persist for Melioidosis (Burkholderia pseudomallei) (MELL- months on wood or sand. It can be transmitted from ee-oy-DOE-siss; burr-cold-AIR-ee-ah sue-doe- person to person, but this is rare. Vaccination has MAL-ee-eye). proved effective in animal tests. Psittacosis (Chlamydia psittaci). (clam-ID-ee-ah sit- ACK-ee). Ricin (toxin from Ricinus communis, or castor Typhus fever (Rickettsia prowazekii) (rick-ETT-see- beans) (Rye-sin-us com-YOU-nis)—This naturally- ahh pro-ah-ZEK-ee-aye). produced toxin could be spread in aerosol form, and can produce symptoms within hours to days. It is stable in the environment, and can be fatal within 10 Category C Agents to 12 days. The Centers for Disease Control and Prevention has classified some agents as Category C, considered Viral encephalitis—(alphaviruses, such as the third-highest priority, because although they are Venezuelan equine encephalitis, Eastern equine not considered effective biological weapons in their encephalitis, Western equine encephalitis)—A viral present form, they might be developed or genetically disease, it is unstable once dispersed, so only those engineered as weapons in the future. They are for directly contaminated in the initial attack will the most part easily available, easy to produce and become ill. It has a low lethality rate, producing disseminate, and have a potential for producing high symptoms in one to six days. rates of disease and mortality. The CDC describes Category C as “emerging infectious disease threats” Food safety threats (e.g. Salmonella species, and lists only two specific examples (Hantavirus and Escherichia coli O157:H7, Shigella) — Globally, the Nipah virus).

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Hantavirus (HAN-tah)—Carried by rodents and technically a chemical weapon, it is produced by mostly transmitted through their droppings, this fungi and therefore sometimes classified with virus was responsible for an outbreak of disease in biological weapons. Arizona and New Mexico in 1993. It causes Hantavirus Pulmonary Syndrome (HPS), which Multi-drug-resistant tuberculosis—Tuberculosis, has now been identified in eight other countries now rare in most countries, remains a major killer in besides the United States (all in the Americas). It has developing nations. It kills about 2 million people been fatal in 45 percent of reported cases, causing per year. Normally, antibiotic treatment cures 95 death through pulmonary edema and respiratory percent of cases, but the resistant strains may require distress. There is evidence of human-to-human aggressive chemotherapy treatment for up to two transmission. years. Recent studies show that more than 4 percent of new cases are of the multi-drug resistant type Nipah Virus (NEE-pah)—A “new” virus, it was (MDR-TB). discovered in Malaysia in 1999, closely related to Hendra virus, discovered in Australia. Both of these Tricothecene mycotoxins (try-CAW-the-seen MY- are Paramyxoviridae. It infects both animals co-TOCK-sins)—This natural toxin could be (mostly pigs) and humans, and has a high distributed in an aerosol form, and begins to mortality rate (50 percent). It begins with flu-like produce symptoms within two to four hours (one of symptoms, and can progress to encephalitis (brain the fastest-acting biological agents) which can inflammation) and coma. persist for days to months. It is moderately lethal, and extremely stable—at room temperature, it can Other possible remain dangerous for years. There is no vaccine. biological weapons Other possible agents: A variety of other agents have been developed, and in some cases even stockpiled, by some nations Bacteria: Trench fever (Bartonella quintana) and as possible biological weapons. Others have been scrub typhus (Orientia tsutsugamushi). named by the World Health Organization and other agencies as possible bioweapons. Some of these are Fungi: Coccidioidomycosis (Coccidiodes immitis) specific examples that fall within categories already and histoplasmosis (Histoplasma capsalatum). included in the CDC list. Since many of these agents were actually developed for warfare by at least one Protozoa: Naegleriasis (Naeglaeria fowlerii), nation, their potential as weapons is not just toxoplasmosis (Toxoplasma gondii), and theoretical. In addition to those described schistosomiasis (Schistosoma). previously, these include the following. Viruses: Hantaan/Korean hemorrhagic fever, sin Aflatoxin (AFF-lah-TOCK-sin)—Although not nombre, Crimeo-Congo hemorrhagic fever, usually considered a candidate for a biological lymphocytic choriomeningitis, Junin (Argentine weapon, primarily because its effects tend to be very hemorrhagic fever), Machupu (Bolivian long-term (cancer and respiratory disease that take hemorrhagic fever), tick-borne encephalitis, years to develop), aflatoxin was in fact produced on Russian spring-summer encephalitis, Omsk a large scale as a weapon, mounted in munitions hemorrhagic fever, Japanese encephalitis, and missiles, and perhaps used against Iranian Chikungunya, O’nyong-nyong, monkeypox, white civilians, by Iraq in the 1980s and 1990s. Although pox (a variant of variola), and influenza.

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Usual Agent Type Structure Transmission Incubation Treatment

Bacteria Single-celled Inhalation, ingestion, 1 week Antibiotics, prophylactics organisms insect bite, wound (range hours to months) vaccination exposure Virusus DNA, RNA Inhalation, insect bite 1-2 weeks Antivirals, vaccination requiring other (range 2 days to 3 weeks) cells to replicate Rickettaias Bacteria requiring Inhalation, insect bite 1-2 weeks Antibiotics other cells to (range 3 days to 2 weeks) replicate Poisonous substances Inhalation, ingestion, 5 minutes-several hours Anti-sera, specific Toxins produced by animals, injection (range 5 minutes to 12 hours) pharmacological preparations plants, etc

Agricultural bioterrorism Karnal bunt of wheat—Even though it has little impact on wheat productivity, 80 countries ban Although most concerns have focused on wheat imports from areas where the disease has human pathogens, a biological attack against been found. A single outbreak in Arizona in 1996, crops or livestock is also considered a possibility. A probably because of an accidental introduction study by the National Research Council concluded across the border from Mexico, posed a threat to that such an attack would almost certainly not be that state’s $6 billion in wheat exports, and caused capable of producing famine or widespread over $100 million in actual losses, in addition to malnutrition in the United States, but it could $60 million spent on control efforts. nevertheless have a severe economic impact. One study showed that an outbreak of foot and mouth Mad Cow Disease (MCD)—Though its actual disease (a cattle disease) in California alone, even impact on cattle is relatively minor, outbreaks if contained within three months, could cause a have had devastating economic impact, as in loss of $6 billion to $13 billion. England and much of Europe in 1996. In Japan in 2001, the detection of just three cases of the Some of the plant and animal diseases considered disease led to a 50 percent reduction in beef sales. to pose the greatest threat: So far, there have only been two documented U.S. cases, in late 2003, which were both traced to cows Avian flu—Can have a serious economic impact. from a Canadian herd. An outbreak in the United States in the mid-1980s resulted in the destruction of 17 million birds at a Swine fever—An outbreak in the Netherlands in cost of $65 million. Found in humans only in 1997-’98 was caused by swine imported from Vietnam and Thailand as of early 2004. Germany, and illustrated how a rapid outbreak could follow a single introduction into a previously Foot and mouth disease (FMD)—Can have uninfected country. serious economic impact, though its effects on cattle are relatively minor. To avert potential losses Other plant pathogens that have been named as from exports, Taiwan spent $4 billion in an possible weapons include stem rust (in wheat), attempt to eradicate the disease in 1997, without sorghum ergot, and barley stripe rust. success.

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There is no accepted list of the most likely might progress to a point at which control will be biological agents that might be used against crops, difficult and expensive before being detected. and some researchers have suggested (e.g. Wheelis Some other nations, with a less diverse et al., BioScience, July 2002) that developing such agricultural base than the United States, could a list is an important first step toward monitoring suffer more serious health and economic effects to detect a possible attack. At present, an outbreak from such an attack.

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Laws and Treaties That Govern Biological Warfare

Several international covenants currently pertain to biological warfare and bioterrorism. They vary in their language and membership, but none have verification or enforcement regimes, so some signatories and “states parties” (those nations that have both signed and ratified the covenants) do not adhere to their provisions.

The Biological and Toxins conference took place in Geneva in November 2002 despite some pressure from the Bush Weapons Convention administration to delay further discussions until Short Description 2006. The administration contended that treaty The most widely established covenant is the revisions proposed by European Union and other Biological and Toxins Weapons Convention (BWC), countries—such as a legally binding enforcement which prohibits the development, production, protocol—would not work to deter state sponsors The Biological stockpiling or acquisition of biological agents or of terrorism from developing biological weapons and Toxins toxins “of types and in quantities that have no and should not be pursued at this time. justification for prophylactic, protective and other However, the 2002 meeting decided to try to Weapons peaceful purposes.” The BWC also forbids accelerate progress by planning a series of annual Convention also weaponization of biological agents and toxins as meetings to take place before the next formal well as developing means of dissemination. It does meeting in 2006. These are expected to be forbids allow defensive biological warfare research, preceded by two-week meetings of experts. The weaponization of including the development of vaccines and focus in 2003 was on national measures to adopt protective equipment. No verification regime has the convention’s prohibitions, and on ways to biological agents been established, and the convention requires only ensure the security of pathogens. In 2004, the and toxins as well that parties voluntarily provide information about focus is on enhancing international coordination national biological activity. The convention was for responding to biological attacks or as developing signed in London, Moscow and Washington, D.C. in investigating new outbreaks of disease, and in April 1972 and entered into force in 1975. There are 2005 the focus will be on codes of conduct for means of currently 167 signatories, 151 of which have ratified scientists. dissemination. the convention. A review conference is held every four years, Citations and recent conferences have focused on The following paragraphs encapsulate the BWC’s establishing verification measures. The last review key provisions:

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“The States Parties to this Convention, The Geneva Protocol “Determined to act with a view to achieving Short Description effective progress towards general and complete While the BWC is currently the primary disarmament, including the prohibition and covenant on biological weapons, the Geneva elimination of all types of weapons of mass The Geneva Protocol was the first multilateral international destruction, and convinced that the prohibition of agreement to address chemical and biological Protocol was the development, production and stockpiling of weapons. It bans “the use in war of asphyxiating, chemical and bacteriological (biological) weapons poisonous or other gases and of all analogous signed in 1925 and their elimination, through effective measures, liquids, materials or devices” and prohibits and entered into will facilitate the achievement of general and “bacteriological methods of warfare.” The Geneva complete disarmament under strict and effective Protocol is considered part of customary force in 1928. international control, international law and therefore binds even states that are not signatories to it. The protocol has no The protocol “...Determined, for the sake of all mankind, to exclude verification regime, and many of the signatories completely the possibility of bacteriological (biological) currently has 132 have stated that if chemical or biological weapons agents and toxins being used as weapons, states parties were used against them, they reserve the right to “Convinced that such use would be repugnant to the respond in kind. The protocol was signed in 1925 (nations that conscience of mankind and that no effort should be and entered into force in 1928. The protocol have signed and spared to minimize this risk, currently has 132 states parties (nations that have signed and ratified the Protocol) and one signatory. “Have agreed as follows: ratified the “...never in any circumstances to develop, produce, Citations Protocol) and one stockpile or otherwise acquire or retain: The following text summarizes the Geneva Protocol: signatory. “(1) Microbial or other biological agents, or toxins whatever their origin or method of production, of types “Whereas the use in war of asphyxiating, poisonous or and in quantities that have no justification for other gases, and of all analogous liquids, materials or prophylactic, protective or other peaceful purposes; devices, has been justly condemned by the general opinion of the civilised world; and “(2) Weapons, equipment or means of delivery designed to use such agents or toxins for hostile “Whereas the prohibition of such use has been purposes or in armed conflict.” declared in Treaties to which the majority of Powers of the world are Parties; and Further articles of the BWC discuss the destruction of existing weapons, export control of “To the end that this prohibition shall be universally agents and the technology required to produce accepted as a part of International Law, binding alike them, adherence to the Convention, and periodic the conscience and the practice of nations; review conferences. “Declare:

Status of State Sponsors of “That the High Contracting Parties, so far as they are Terrorism not already Parties to Treaties prohibiting such use, Iraq, Iran, Libya and Cuba all signed and ratified accept this prohibition, agree to extend this prohibition the convention. Syria signed the convention but did to the use of bacteriological methods of warfare and not ratify it. North Korea and Sudan are not agree to be bound as between themselves according to signatories. the terms of this declaration.”

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Status of State Sponsors of biological industries are a target for proliferators as a Terrorism source of materials for CBW programs. Iran, Iraq, Libya, Sudan, Syria, North Korea and “Participating countries have recognised from the Cuba all signed and ratified the Geneva Protocol. outset that export licensing measures are not a substitute for the strict and universal observance of the 1925 Geneva Protocol and the 1972 Biological and The Australia Australia Group Toxin Weapons Convention (BWC) and the early Group is a loose Short Description implementation of and universal adherence to the The Australia Group is a loose association of Chemical Weapons Convention (CWC), which association of nations that agree not to export materials that could entered into force on 29 April 1997. All members of the nations that be used to produce chemical or biological weapons. Australia Group are States Parties to both the BWC The Group formed in 1985 in response to the and the CWC. agree not to revelation that chemical weapons had been used in “...Export licensing measures also demonstrate the export materials the Iran-Iraq war and began to address biological determination of participating countries to avoid not issues in 1990 as evidence suggested that legal that could be only direct but also inadvertent involvement in the biological equipment was being used for illegal spread of chemical and biological weapons, and to purposes. The list of controlled items for biological used to produce express their opposition to the use of these weapons.” weapons includes both technological items for chemical or production and specific agents and toxins. The Status of State Sponsors of Group meets annually to discuss how best to create biological and enforce export controls to help stem the Terrorism Iran, Iraq, Libya, Syria, Sudan, North Korea and weapons. proliferation of chemical and biological weapons. Cuba are not members of the Australia Group. The agreement is not legally binding, so the Group strives to ensure that the export control measures are easy to implement and do not interfere with The Need for New Criminal Laws A number of groups, notably the Harvard-Sussex regular trade, while remaining effective in Program, have long advocated a new international preventing proliferation. The Group presently has criminal law that would classify the use of biological 34 participants, all of which are parties to the weapons as a crime with universal jurisdiction, a Biological Weapons and Toxins Convention. category already applied to such crimes as airplane Citations hijacking, hostage taking, the theft of nuclear materials, and piracy. At present, the treaties The Group’s written objectives state the following: described above technically apply only to the actions “The principal objective of participants in the of nations against other nations, and do not Australia Group is...to ensure, through licensing explicitly prohibit the use of biological weapons by measures on the export of certain chemicals, biological individuals, terrorist organizations or by a nation’s agents, and dual-use chemical and biological military against its own citizens (as, for example, in manufacturing facilities and equipment, that exports the case of Iraq’s use of chemical and perhaps of these items from their countries do not contribute to biological weapons against its own Kurdish the spread of CBW. The Group does this through population). Some nations, including the United consultation and harmonisation, thus maximising the States, have individually enacted such laws, but there effectiveness of participants’ national licensing is at present no such international agreement. measures. The Group’s activities are especially As the Harvard-Sussex Program notes, “Treaties important given that the international chemical and defining international crimes are based on the

33 A JOURNALIST’S GUIDE TO COVERING BIOTERRORISM concept that certain crimes are particularly substantial assistance to those activities or to dangerous or abhorrent to all and that all states threaten to use biological or chemical weapons. Any therefore have the right and the responsibility to person who commits any of the prohibited acts combat them. Certainly in this category, threatening anywhere would face the risk of prosecution or to the community of nations and to present and extradition should that person be found in the future generations, are crimes involving the hostile territory of a state that supports the proposed use of disease or poison and the hostile exploitation convention.” of biotechnology.” The Harvard Sussex Program notes that with In the wake of the 2001 terrorist attacks, there such a convention in place, “the norm against has been some increased pressure to enact such a chemical and biological weapons would be law, and Canada has formally proposed doing so. strengthened, deterrence of potential offenders At this writing, no action had been taken on this would be enhanced, and international cooperation proposal. in suppressing the prohibited activities would be The project has produced a draft convention that facilitated.” would make it a crime under international law “for Although the Netherlands has shown interest in any person knowingly to develop, produce, acquire, the draft convention, so far no nation has formally retain, transfer or use biological or chemical submitted it to the United Nations General weapons or knowingly to order, direct or render Assembly, which would have to approve it.

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Who Has Biological Weapons?

Nation States Iran Conventions and covenants, no matter how Iran is believed to have large stockpiles of carefully laid out or widely ratified, cannot stop biological weapons, although intelligence on Iran’s nations from developing biological weapons. A program is sparse. number of nations, some of which are signatories of the BWC and/or the Geneva Protocol, Iraq currently are believed to have biological weapons The United Nations Special Commission programs or to be pursuing them. Definitive (UNSCOM) was established in the wake of the 1991 information on exactly which nation states have Gulf War by the U.N. Security Council to oversee the biological weapons is hard to come by. There is a destruction of Iraq’s weapons of mass destruction A number of strong international norm against the production stockpiles. UNSCOM began inspections in 1991 and and use of biological weapons. Openly violating discovered that Iraq had produced 19,000 liters of nations, some of this norm or the numerous agreements botulinum toxin, 8,400 liters of anthrax, and 2,000 which are prohibiting the sale, production, stockpiling and liters of aflatoxin and clostridium, much of which use of these weapons would necessarily condemn had been mounted in munitions and warheads. In signatories of the the nation or group before most of the world, fact, UNSCOM estimated that Iraq may have resulting in sanctions and other diplomatic, produced 10 billion doses of these three agents- BWC and/or the economic or even military actions. Below is an more than enough to infect every human on Earth. Geneva Protocol, alphabetical list of nation states believed to have The agents were primarily produced in facilities at Al biological weapons; because of the Hakam and Al Salman, but a total of 86 sites may currently are aforementioned factors, this list is probably have been involved in the program. In 1988, it had believed to have incomplete. imported 39 tons of growth medium for agents such as anthrax and botulinum toxin. UNSCOM biological China destroyed much of the growth medium, but as weapons China denies having a biological weapons much as 17 tons remain unaccounted for. Iraq program, but some international intelligence admitted to having missiles tipped with warheads programs or to be sources claim to have evidence that a program containing biological weapons agents during the exists. Gulf War. Iraq ceased cooperation with UNSCOM pursuing them. in 1998 and inspections ended. France In 2002, inspections resumed under pressure According to intelligence reports in November from the U.S. and a new U.N. resolution. In 2002, France is believed to be one of four nations February 2003, having declared the inspections that possess unauthorized stocks of the smallpox inadequate, the U.S. attacked Iraq, citing evidence of virus (the others at the time were Iraq, Russia and weapons of mass destruction, including biological North Korea). The French government has said weapons, as a major reason for the attack. such stocks, if they exist, are solely for the Subsequent inspections, however, have found no development of vaccines. evidence of such agents. Most analysts now

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conclude that any such weapons Iraq may have still by the Soviet Union as weapons. When this offensive had after the 1991 Gulf War were destroyed long program ended with the dissolution of the Soviet before the 2003 attack, and all that remained was the Union in 1992, Russia committed to destroying knowledge of some scientists and technicians who existing stockpiles. However, the whereabouts of had experience in setting up production facilities for supplies, samples of agents and many of the With the advent such agents. It remains unclear why Saddam scientists who spent their careers researching and Hussein had resisted inspection efforts if no such developing them are unknown. Nations seeking to of the Internet, weapons were present. develop biological weapons programs recruited the increase in some of these scientists, and samples of viruses and Israel bacteria might have gone with them. Samples and global trade and Israel is believed to have a biological weapons supplies also might have been sold through the mail. travel, and the program, but the details are not known. Russia’s Vector Laboratory is the repository of one of the world’s two known, authorized samples of dissolution of the Libya smallpox virus, but Russia is also believed to posses Soviet Union, Libya was believed to have been pursuing a unauthorized samples. biological weapons program, but the status of the accessibility to program was unknown. As of early 2004, Libya was Syria fully cooperating with international inspectors and Syria is believed to be pursuing a biological information about the details of its biological weapons program are weapons program, but the status of the program is making and using expected to emerge. unknown. weapons of mass North Korea Transnational Groups destruction has North Korea is suspected to have a large stockpile With the advent of the Internet, the increase in of biological weapons, but details are not known. global trade and travel, and the dissolution of the increased rapidly. Both Russian and U.S. intelligence sources have Soviet Union, accessibility to information about reportedly claimed there is evidence that North making and using weapons of mass destruction has Korea has worked on development of weapons increased rapidly. Transnational groups may have using anthrax, cholera, bubonic plague and been the biggest beneficiaries of this change; smallpox. Intelligence reports in November 2002 expertise, equipment and supplies formerly identified North Korea as one of four nations possessed only by nations sponsoring biological believed to possess unauthorized stocks of smallpox weapons programs now are available to anyone with virus. the interest and a fistful of money. But which groups have these weapons? Russia (Former Soviet Union) While it is difficult to estimate nation states’ The former Soviet Union had a massive biological biological warfare capacities, it is even harder to weapons program, with scores of laboratories gather information on the capabilities of scattered across thousands of miles, employing tens transnational groups. By definition, they are not of thousands of people. Several high-level defectors traceable to a single location, and their in the 1990s revealed the extent of the program, organizational structures and activities are more which produced hundreds of tons of anthrax and opaque than those of states. What these groups lack dozens of tons of smallpox and plague, among many in size, compared to states, they compensate for in other viruses, bacteria and toxins. Ken Alibek, terms of advanced infrastructures and significant former director of this program, has written that at resources. With states’ sponsorship, they become least 70 different biological agents were identified as even more effective in planning, carrying out and potential weapons, and 11 were actually developed getting away with terrorist attacks. While a

36 A JOURNALIST’S GUIDE TO COVERING BIOTERRORISM transnational group might not possess laboratory capabilities is poor at best, almost nonexistent at equipment or scientific expertise, a state sponsor worst. with an established program may provide Determining the extent of al Qaeda’s capabilities biological weapons for the group’s use. is obviously a priority now. While evidence exists Aum Shinrikyo was not even on the radar as a that the group possesses a solid chemical weapons terrorist group until its Sarin attack on the Tokyo capability, definitive information about its biological subway in 1995, yet the cult had been capability is not presently available. Some experimenting with chemical and biological international intelligence suggests that the well- weapons for years. It had even carried out several funded, well-connected group is on its way with botched biological weapons attacks in Tokyo purchases of laboratory equipment and the without anyone noticing. Present knowledge of distribution of a how-to guide for manufacturing transnational groups’ biological weapons biological weapons.

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What Can Be Done for Defense

A Good Offense biodetectors in 100 major cities to provide early While the United States no longer has an offensive warning. (However, such detectors have not yet been biological weapons program, the government proven effective.) The study also recommended maintains a defensive program. Designed to improved biolab facilities for identifying the respond to a variety of potential threats, it includes pathogens; pre-deployed vaccines; and regular aggressive measures to develop early warning educational sessions for those likely to be called systems; educate first responders and the public upon to respond. health community; produce and stockpile vaccines, International cooperation also will be necessary antibiotics and other medical supplies; establish to keep certain biological agents away from ill- intentioned parties. Domestically, the nation must Intelligence, both efficient laboratory capabilities; and expand hospital systems to accommodate attack victims. closely monitor such agents. Obtaining a sample of domestic and Inter- and intraorganizational exercises and anthrax once required little more than sending a tabletops (verbal exercises carried out around a table request on letterhead, but new policies and international, is instead of full-scale in the field), ever-improving procedures now restrict and monitor the sharing of an important work on modeling (computer simulations of such agents. infection progressions and patterns), and more The National Research Council, the U.S. building block in aggressive intelligence gathering are just some of the government’s official research agency, in June 2002 the preparedness ways in which the United States has and can actively issued a report titled “Making the Nation Safer: The increase preparedness for a biological attack. Key Role of Science and Technology in Countering structure. areas that will require extra attention and Terrorism,” that said the United States remains unprecedented cooperation include intelligence, highly vulnerable to a terrorist attack, including one international cooperation and public with biological weapons. The report concluded communications. there are serious shortcomings in the nation’s Intelligence, both domestic and international, is preparedness for a biological attack. an important building block in the preparedness Among the challenges cited in the report were structure. Because of the crucial time elements the need to develop vaccines for airborne involved in biological warfare, prior knowledge of a pathogens, the need for better sensors to detect possible attack could drastically mitigate its effects. such agents and filters to protect against them, A study published in 2003 by Abt Associates found better systems to protect the nation’s food supply, that a worst-case bioweapons attack could produce and the need for a “coherent overall strategy” for up to 3 million deaths and an economic impact of coordination of the myriad federal, state and local up to $630 billion (not counting the value of the agencies. Because of the divisions between lives lost). But, the same study concluded, agencies responsible, the report said, “the Federal countermeasures that might cost $10 billion a year government is not appropriately organized to could reduce the maximum death toll by a thousand carry out” a science and technology agenda to fold, to 3,000, and the economic losses to $21 billion. counter large-scale terrorism. One new program The recommendations included installing 10,000 under discussion is to have the U.S. Postal Service

38 A JOURNALIST’S GUIDE TO COVERING BIOTERRORISM ready to respond with mass mailings of antibiotics A Good Public Health Policy to U.S. households in the event of a biological attack. Some specialists feel that public health was This would only be effective against certain agents, neglected for decades in the United States. While however. some preparations began years ago, the anthrax attacks in 2001 were a wake-up call for the nation, New Technology for Detection signaling that the public health system was not One of the Several promising projects have yielded detectors equipped to handle biological terrorism on any greatest that are either available now or may soon become scale. Of course, public health needed an infusion of practical for widespread use. Here are some money, but more importantly, a cohesive public challenges to this examples of recent developments: health community was needed to face challenges • A device developed at Washington University in with a united front. Emergency room doctors, state coordination and St. Louis is said to capture and destroy a variety of and local public health officials, rural clinicians, first cooperation effort airborne pathogens, including smallpox, anthrax, responders and federal public health officials all and ricin, and is small enough to be installed in needed not only to talk but also to forge working is that no one aircraft in addition to public buildings. It uses x- relationships. has a great deal rays, electrostatic fields and catalysts to deactivate Once the public health community is internally any organic molecules that pass through it. coordinated, the public health system—from of experience in • A system being developed by a researcher at individual paramedics to the Department of Health the field of NASA’s Jet Propulsion Laboratory and the and Human Services—will need to coordinate and California Institute of Technology is designed to cooperate effectively with all agencies and bioterrorism detect a particular compound given off by departments involved in emergency preparedness response. bacterial spores. Installed in large public spaces, it and response. These include fire and police should be able to detect individual spores of departments; local, state and federal emergency agents such as anthrax, days before anyone management agencies; the military; and intelligence exposed might begin to display symptoms. This agencies, among others. could greatly speed up response to an attack and One of the greatest challenges to this prevent its wide spread into the population. coordination and cooperation effort is that no • The U.S. Army is developing a system for one has a great deal of experience in the field of recognizing clouds of aerosol particles, using a bioterrorism response. Turf wars, laser-based equivalent of radar called LIDAR. It is miscommunications and inadequacies of expected to be able to detect such clouds, information are therefore more likely and more characteristic of an airborne bioweapons attack, dangerous. Experts from a variety of fields must from great distances, with the ability to pool their knowledge and form an effective public discriminate accurately between different health policy for a type of event of which we have biological agents. only seen two examples—the relatively minor • Disposable hand-held assay kits. These typically bioterrorism attack of the Rajneesh followers in use enzymes to detect specific agents and produce 1984, and the anthrax attacks by mail in 2001. This a visible glow in the presence of the target public health policy will have to address a wide compound. Typical units available now cost $20 range of issues, including drug stockpiles, the per test and take about 20 minutes to give a result. control of dangerous agents, and whom to • The Biowatch program, set up in July 2003, has vaccinate before and after an attack. Most 500 air monitors in 31 cities that are checked importantly, though, this policy must unite a nation every 12 hours and tested for various biological of scattered public health interests into an effective agents using genetic tests. bioterrorism preparedness and response machine.

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New computer systems are actively being good sources about bioterrorism and researching developed to monitor everything from emergency how to contact them in case of an emergency, room admissions to the sales of pharmaceuticals, journalists can secure access to those who are truly looking for patterns that might not be apparent to knowledgeable and avoid mistakes the next time individual doctors or pharmacists but might around. Knowing exactly indicate the beginnings of a suspicious outbreak. For Journalists will need access to experts in a variety example, one of the first indicators that revealed a of fields—from virology to crisis management— whom to call… natural outbreak of water-borne cryptosporidium from both inside and outside the government. could prevent a infection in Milwaukee the 1990s was an increase in Media outlets can start now to contact those few sales of Kaopectate. Such a system, according to experts who are widely recognized as such and seek lot of last-minute officials at the office of the secretary of defense for recommendations on other appropriate people to scrambling and chemical and biological defense, would include interview or consult in the event of an attack. By biodetection, using information from medical contacting established academic institutions, think on-air uncertainty surveillance systems and environmental sensors, tanks, medical associations and experienced and integrating the data into one comprehensive government officials, journalists can compile a system. strong list of contacts before an attack, alleviating concerns about airing or printing information and Good Public Information opinions that might not turn out to be as Among the myriad necessary preparedness authoritative as they were originally touted to be. efforts, public communications plans are In particular, it could make a big difference in paramount. Coordination and cooperation between covering an unfolding attack to have spent the time government and the media will be critical to ensure beforehand getting to know who is really in charge early, clear and accurate reporting of facts and of public health decisions—from the local level on events. Constructive dialogues between journalists up through county, state and federal agencies—and and government officials before an attack occurs can knowing what kinds of plans they have drawn up for establish crucial lines of communication, and dealing with a biological weapons attack. Knowing prescreening of experts can help to prevent exactly whom to call, before the phones start ringing unnecessary confusion, conflicting information and off the hook, and knowing what procedures they even misinformation. The sections below suggest a will be following, could prevent a lot of last-minute few steps the media might take toward ensuring scrambling and on-air uncertainty. informed reporting on bioterrorism. Some Questions to Think About Finding the Experts Reliable reporting might be enhanced by By locating and making contact with experts in addressing certain questions about the response to advance who can be reliable, knowledgeable sources an attack in advance. This would give journalists following a bioterror attack, and becoming familiar much needed background material and provide with public health plans, journalists can minimize them with a more solid understanding of exactly the inevitable confusion and misinformation that how events might unfold during an actual attack. would ensue. Media coverage following the anthrax More important, those directing response efforts attacks in 2001 showed that there’s no certification may not be available for lengthy interviews and a or license to be an “expert,”and the scramble to find multitude of questions should an attack occur. sources yielded a surprising array of people, Questions about preparedness and response regardless of experience and education, who got protocols could be directed to officials at all levels of their words on the air or in print. By pre-vetting government, from the local fire chief to cabinet

40 A JOURNALIST’S GUIDE TO COVERING BIOTERRORISM members in Washington and might include the local fire departments and hospitals can no longer following questions: afford to take a “wait and see” stance. Neither How do health care professionals report should the media. suspicious cases? How does the government receive, process and respond to these reports? Who Conclusion decides when the government should mount a Communication before, during and after a response? How do the various agencies and biological attack will be a critical element in departments coordinate their actions during the effectively responding to the crisis and helping response? Who is in command, and what is the people to protect themselves and recover. chain of command? What elements are involved Misinformation—or even accurate information in a response, and who is responsible for each? relayed in an overblown manner—could What is the timeline for each element of a undermine even the best response and cause response? unnecessary deaths, chaos, panic and instability. While many obvious contingencies cannot be Even a handful of poorly produced media reports accounted for in advance, immediate access to a could undermine antibioterrorism efforts at the substantial amount of basic information could local, state and federal levels. The news media are help ensure accurate reporting as soon as key to an informed public—and to the preparedness authorities detect an attack—a period especially and response efforts of the nation. Responsible, prone to misinformation and potentially sensitive coverage gives citizens improved ability to inflammatory reporting. In preparing a good understand events and offers them better prospects defense against biological warfare, government, for quick recovery from a biological attack.

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Where to Get Information

Government, International and Public National Institutes of Health Health Sources Web site: www.nih.gov Centers for Disease Control and Prevention (CDC) NIH has good information and links on biological weapons agents at Web site: www.cdc.gov the National Library of Medicine site: Phone: 1-800-311-3435 http://sis.nlm.nih.gov/Tox/biologicalwarfare.htm Media Relations: 404-639-3286 Media Relations web site: http://www.cdc.gov/od/oc/media/ World Health Organization Additional information on bioterrorism: www.bt.cdc.gov Biological weapons (which WHO refers to as “deliberate epidemics”) Specific information on hoaxes and rumors relating to biological Web site: www.who.int/csr/delibepidemics/en/ weapons: www.cdc.gov/hoax_rumors.htm Media Center web site: www.who.int/mediacentre/en/

Center for Drug Evaluation and Research (U.S. Food and Drug Administration) U.S. Military Sources Has extensive information on drug preparedness (vaccines, antibiotics) Anthrax Vaccine Immunization Program (AVIP) Agency. for a bioweapons attack. Provides information on anthrax including: why anthrax is a threat, Web site: www.fda.gov/cder/drugprepare/ what the anthrax vaccine is, what the vaccine does, history of anthrax and a facts vs. myths section. Chemical and Biological Defense Programs Web site: www.anthrax.osd.mil (U.S Dept. of Energy, Pacific Northwest National Laboratory) Information on detection and decontamination. CBIAC (Chemical Warfare/Chemical Biological Defense Web site: http://www.pnl.gov/chembio/ Information Analysis Center) CBIAC serves as the Defense Department’s focal point for CW/CBD Federal Emergency Management Agency (FEMA) technology. It collects, reviews, analyzes and summarizes information Web site: www.fema.gov and provides a searchable database for authorized users and links to many other CW/CBD related sites. National Disaster Medical System Web site: www.cbiac.apgea.army.mil (U.S. Dept. of Health and Human Services) This web site is aimed at disaster responders, public health officials, Defense Technical Information Center emergency managers and practitioners. DTIC is the central Department of Defense facility for the exchange of Web site: ndms.dhhs.gov scientific and technical information. Web site: www.dtic.mil National Institute of Allergy and Infectious Diseases (NIAID) A division of NIH, NIAID has its own useful web site with information Defense Threat Reduction Agency (DTRA) on biological weapons and defensive measures. DTRA consolidates a variety of Defense Department functions to deal Web site: www.niaid.nih.gov/biodefense/ with threats posed by WMD. Web site: www.dtra.mil

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U.S. Army Edgewood Chemical Biological Center Chemical Biological Database The Army’s principal R&D center for chemical and biological defense The Joint University of Bradford-SIPRI Chemical and Biological technology, engineering and service. Warfare Project provides information on the 1993 Chemical Weapons Web site: www.edgewood.army.mil Convention (CWC), the 1972 Biological and Toxin Weapons Convention (BTWC) and related issues. U.S. Army Homeland Defense Web site: www.brad.ac.uk/acad/sbtwc Web site: hld.sbccom.army.mil Chemical and Biological Weapons Nonproliferation Project U.S. Army Nuclear, Biological and Chemical Defense Program This project serves as a problem-solver and an information Web site: www.pmnbc.army.mil clearinghouse in the general subject areas of CB treaties, chemical demilitarization (especially in Russia), CB terrorism and related areas. U.S. Department of Defense Global Emerging Infections Sponsored by The Stimson Center, Washington, DC. Surveillance and Response System Web site: www.stimson.org/cbw Web site: www.geis.ha.osd.mil Federation of American Scientists, Chemical & Biological Weapons Arms Control Program Academic Institutions and Nonprofit Web site: fas.org/bwc Organizations Center for Biosecurity (University of Pittsburgh Medical Center) Harvard Sussex Program on CBW Armament and Arms Limitation Web site: www.upmc-biosecurity.org The Harvard Sussex Program is an international program of research and communication to promote the global elimination of chemical Center for Infectious Disease Research & Policy (University of and biological weapons and to strengthen the constraints against Minnesota) hostile uses of biomedical technologies. Good information and links on infectious diseases and bioweapons. Web site: www.sussex.ac.uk/spru/hsp Web site: www.cidrap.umn.edu Infectious Diseases Society of America Center for Nonproliferation Studies (Monterey Institute of Bioterrorism information and resources. International Studies) Web site: www.idsociety.org/BT/ToC.htm Claims to be the world’s largest non-government organization devoted to combating the spread of weapons of mass destruction. Chemical Stockholm International Peace Research Institute and biological weapons resource page Information on actual and potential uses of chemical and biological Web site: cns.miis.edu/research/cbw weapons. Web site: projects.sipri.se/cbw Center for the Study of Bioterrorism & Emerging Infections (St. Louis University) This center produces an excellent set of “Fact Sheets” about different BOOKS potential biological weapons. “America’s Achilles’ Heel: Nuclear, Biological, and Chemical Web site: www.bioterrorism.slu.edu Terrorism and Covert Attack (BCSIA Studies in International Security)” Chemical and Biological Arms Control Institute By Richard A. Falkenrath, Robert Newman and Bradley Thayer. Nonprofit corporation established to promote arms control and Paperback. Cambridge: MIT Press, 1998. nonproliferation, with a special focus on elimination of chemical and biological weapons. Web site: www.cbaci.org

43 A JOURNALIST’S GUIDE TO COVERING BIOTERRORISM

“Biohazard: The Chilling True Story of the Largest Covert Biological “The Survival Guide: What to Do in a Biological, Chemical, or Weapons Program in the World-Told From the Inside by the Man Nuclear Emergency” Who Ran It” By Dr. Angelo Acquista. Paperback. New York: Random House, 2003. By Ken Alibek with Stephen Handelman. New York: Random House, From the medical director of the New York City Mayor’s Office of 1999. Emergency Management, this is a step-by-step guide to protecting oneself in large-scale emergencies. “Biological Weapons Defense: Principles and Mechanisms for Infectious Diseases Counter-Bioterrorism (Infectious Disease)” “The Demon in the Freezer: A True Story” By Luther Lindler, Frank Lebeda, George Korch, editors. Humana Press, By Richard Preston. New York: Random House, 2002. 2004. A detailed account of smallpox and its potential danger as a biological weapon. “Biosecurity: Limiting Terrorist Access to Deadly Pathogens” By Jonathan B. Tucker. U.S. Institute of Peace, 2003. Online report, “Facing the Unexpected: Disaster Preparedness and Response in the downloadable in pdf format at United States” http://www.usip.org/pubs/peaceworks/pwks52.html By Kathleen Tierney, Michael Lindell and Russell W. Perry. John Henry Press, 2001. “Bio-Terrorism: How to Survive the 25 Most Dangerous Biological Weapons” “First Responder Chem-Bio Handbook” By Pamela Weintraub, Paul Rega. Citadel Trade, 2002. By Ben Venzke. Tempest Publishing, 1998. A hands-on approach for those who will need to deal with emergency “Bioterrorism and Public Health: An Internet Resource Guide” situations, covering signs and symptoms, diagnosis, treatment, By John G. Bartlett, Tara O’Toole, Thomas V. Inglesby, Mair Michael. decontamination and precautions. Thomson Healthcare, 2002. This is a list of 500 web sites from U.S. government sources. May be slightly out of date. “Germs” By Judith Miller, Stephen Engelberg and William Broad. New York: “The Cobra Event” Simon & Schuster, 2001. By Richard Preston. New York: Random House, 1998. Written by three New York Times reporters, this book details the Fictional but highly detailed and fact-based account of a bioterrorism dangers of biological weapons and contends that they are not as attack involving a fabricated agent. President Bill Clinton considered it difficult to make and distribute as some others claim. so important he convened a panel of experts and increased the federal budget for research on defenses against biological weapons after “Jane’s Chem-Bio II Handbook” reading it. By Frederick R. Sidell, William Patrick and Thomas Daschle. Spiral- bound. Jane’s Information Group, 2002. “Combating Chemical, Biological, Radiological, and Nuclear The original version was considered the professional standard since Terrorism: A Comprehensive Strategy: A Report of the CSIS 1998, and it has been reissued in a new edition in September 2002. Homeland Defense Project” Written by top experts in the field and used by many federal, state and By Frank J. Cilluffo, Sharon L. Cardash and Gordon N. Lederman. local law enforcement, fire and emergency responders. Paperback. Center for Strategic and International Studies, 2001. “Living Terrors” “The US Armed Forces Nuclear, Biological and Chemical Survival By Michael T. Osterholm and John Schwartz. New York: Delacorte Manual” Press, 2000. By Dick Couch (Compiler), John Boswell. New York: Basic Books, 2003.

44 A JOURNALIST’S GUIDE TO COVERING BIOTERRORISM

“The New Craft of Intelligence: Personal, Public, & Political: CD-ROMs Citizen’s Action Handbook for Fighting Terrorism, Genocide, Disease, “2002 Bioterrorism After the Anthrax Attacks: Complete Revised Toxic Bombs, & Corruptions” Guide to Biological Weapons and Germ Warfare-Anthrax, Smallpox, By Robert David Steele. OSS International Press, 2002. Medicines, Treatment, Preparedness, White House, Homeland Security, CDC, HHS, FDA, NIH, Military Manuals” “Weapons of Mass Destruction : The No-Nonsense Guide to Washington, D.C: U.S. Government, Progressive Management, 2002. Nuclear, Chemical and Biological Weapons Today” This updated CD-ROM contains 12,415 pages of documents. By Robert Hutchinson. Cassell Academic, publication in April 2004. “21st Century Complete Guide to Bioterrorism, Biological and “PDR Guide to Biological and Chemical Warfare Response” Chemical Weapons, Germs and Germ Warfare, Nuclear and By John G. Bartlett (Editor), David Sifton. Medical Economics, 2002. Radiation Terrorism: Military Manuals and Federal Documents Paperback. With Practical Emergency Plans, Protective Measures, Medical Treatment and Survival Information” “Preparedness for the Deliberate Use of Biological Agents: A Washington, D.C: U.S. Government, Progressive Management, 2001. Rational Approach to the Unthinkable” This comprehensive CD-ROM contains over 30,000 pages in 146 World Health Organization, Geneva, May 2002. documents (occupying over 600 MB) from all major federal agencies, Available for download at: including the Department of Defense, U.S. Army, Federal Emergency www.who.int/emc/pdfs/WHA_TerrorismW.pdf Management Agency (FEMA), Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), “Public Health Response to Biological and Chemical Weapons: Department of Energy, Nuclear Regulatory Commission (NRC), EPA, WHO Guidance” and GAO. Gives detailed, practical and current information on the 2nd edition, World Health Organization, 2003. NBC (nuclear, biological and chemical) threat. Descriptions of Available for download (draft version) at: biological and chemical agents, history, agent delivery methods, http://www.who.int/csr/delibepidemics/biochemguide/en/index.html environmental detection, prevention, military equipment and civilian emergency plans. “Saddam’s Bombmaker: The Terrifying Inside Story of the Iraqi Nuclear and Biological Weapons Agenda” “Bioterrorism Awareness Training” By Khidr Abd Al-Abbas Hamzah, et al. New York: Scribner, 2000. Center for Food Security and Public Health, Iowa State University. Contains in-depth PowerPoint presentations and fact sheets on CDC “When Every Moment Counts: What You Need to Know About category A, B, and C potential bioterrorism agents. Bioterrorism from the Senate’s Only Doctor” Web site: http://www.vetmed.iastate.edu/services/institutes/cfsph/ By Bill Frist. Rowman & Littlefield, 2002. ProductList/resources_cdrom.htm

“21st Century Bioterrorism and Germ Weapons-U.S. Army Field Manual for the Treatment of Biological Warfare Agent Casualties (Anthrax, Smallpox, Plague, Viral Fevers, Toxins, Delivery Methods, Detection, Symptoms, Treatment, Equipment)” By U.S. Department of Defense. Ring-bound. Progressive Management, 2001. This is the manual currently used by U.S. Armed Forces Medical Services to respond to any biological weapons use.

45 A JOURNALIST’S GUIDE TO COVERING BIOTERRORISM

Glossary [Note: Words shown in bold type have their own glossary entries.]

Aerosols—Particles of liquid or solid Antibiotics—Antibiotics, which can treat in 1972, 167 countries now are signatories, material small enough to remain airborne bacterial diseases, can be effective against and 151 have ratified it. indefinitely and thus spread widely. The plague and anthrax, but are useless against preferred size range for biological weapons viruses, such as smallpox, and toxins, such as Biopreparat—The massive Soviet biological agents is small enough to be easily inhaled botulinum. weapons program that produced hundreds of but large enough to become lodged in the tons of anthrax and tens of tons of smallpox lungs rather than immediately exhaled. Aum Shinrikyo—A religious sect in Japan and plague, among other agents. Before the that attempted numerous times to carry out Soviet Union collapsed, Biopreparat Aflatoxin—Although not usually considered biological weapons attacks, but which did not employed more than 30,000 people at more a candidate for a biological weapon, aflatoxin cause any deaths or disease. In 1995, the than 40 sites. was in fact produced on a large scale as a group released Sarin, a chemical nerve gas, in weapon by Iraq in the 1980s and 1990s. the Tokyo subway system, killing 12 people Biosafety—Containment levels have been Although technically a chemical weapon, it is and injuring thousands. defined by the CDC for Biosafety Levels 1 produced by fungi and therefore sometimes through 4, reflecting increasing danger. Each classified with biological weapons. Australia Group—A loose association of level requires a specific set of clearly defined nations dedicated to controlling the export of protective clothing, ventilation, Al Qaeda—Transnational terrorist any items that could be used to produce construction, etc. organization, which various international biological weapons. It was formed in 1985 to intelligence sources suggest either has or is address chemical weapons and began to Bioweapon — A biological weapon; that is, a developing a biological weapons capability. address biological issues in 1990. type of bacteria, virus, or biologically produced toxin that can or might be made AMRIID—The U.S. Army Medical Research Avian flu—An emerging new disease in into a weapon. Institute of Infectious Diseases, it does humans in late 2003 and early 2004, found research aimed at medical responses to only in Vietnam and Thailand as of early Botulinum — A toxin, produced by the biological weapons attacks or natural 2004. It is considered an example of a new bacterium Clostridium botulinum, which is epidemics. Located at Fort Detrick, Md., it strain of disease that might someday trigger a one of the most poisonous known houses the military’s largest Biosafety Level 4 pandemic. substances. The CDC lists it as a Category A containment facility. biological agent. Bacterium, bacteria—Single-celled Anthrax—A bacterium that can remain in organisms, some of which can infect humans, Brucella—A toxin produced by bacteria, dormant spore form for decades and can usually through the lungs, skin or intestines, which is considered a potential bioweapon. infect the skin, lungs or gastrointestinal and release destructive toxins. The CDC lists it as a Category B agent. system in humans. The pulmonary form (tiny inhalable particles) is the most deadly Biological and Toxins Weapons Convention Bubonic plague—Usually transmitted by flea and considered the most likely form to be (BWC)—The primary covenant governing bites, this form of the bacterial (Yersinia used in a biological attack. biological weapons today, the Convention pestis) disease was responsible for the Black prohibits all activity associated with offensive Death in medieval Europe and was used as a biological weapons production. First signed weapon by Japan against China in World War

46 A JOURNALIST’S GUIDE TO COVERING BIOTERRORISM

II. It is considered an unlikely weapon in Sarin and cyanide. Enterotoxin B—A toxin produced by modern times because the inhalational Staphylococcus bacteria. It is listed by the (pneumonic) form is considered capable of Cidofovir—An antiviral treatment option for CDC as a Category B potential bioweapon. causing much higher casualties. those suffering from adverse reactions to the smallpox vaccine. Epidemic—An outbreak of disease that BWC—Biological and Toxins Weapons attacks many people at about the same time Convention. Ciprofloxacin—An antibiotic used to treat and may spread through one or several bacterial infections such as anthrax and communities. Category A—The group of biological agents plague. currently believed by the CDC to pose the Epsilon toxin—Produced by the bacteria greatest threat as biological weapons. Contagion—The process by which one Clostridium per fringens and a common cause Category A includes anthrax, smallpox, person infected with a disease passes it to of food poisoning. It is listed by the CDC in plague, tularemia, botulinum and viral another, either through direct skin contact, Category B of potential bioweapons. hemorrhagic fevers. inhaled droplets or contact with contaminated materials. Some potential FEMA—The U.S. Federal Emergency Category B—Potential biological weapons biological weapons, such as anthrax and Management Administration. In case of a listed by the CDC as being moderately easy botulism, are not contagious, while smallpox national emergency, including a biological to disseminate. They can cause moderate and plague are highly contagious. weapons attack, this agency would be amounts of disease and low fatalitity rates responsible for coordinating local and but may require specific public-health action. Cuba—One of the nations currently on the imported emergency response teams. State Department’s list of state sponsors of Category C—Described by the CDC as terrorism. Flu—See Influenza. emerging infectious disease threats that might at some point be engineered to produce Cutaneous—Contracted through direct Foot and mouth disease (FMD) — A disease biological weapons. The CDC names contact with the skin. Among possible of cattle, it might be used as a weapon Hantavirus and Nipah virus in this category. biological weapons, anthrax, plague and because of its potential economic impact on smallpox can be contracted cutaneously, as beef sales, especially for export. CBN—Chemical, biological and nuclear can the toxins botulinum and mycotoxins. weapons. Also known collectively as weapons Fungus—A group of relatively primitive and of mass destruction. Doxycycline—An antibiotic used to treat often parasitic organisms, including certain bacterial infections, including anthrax mushrooms, yeasts, rusts, molds, and smuts, CBW—Chemical and biological weapons. and plague. some of which produce mycotoxins.

CDC—Centers for Disease Control and Ebola—A viral hemorrhagic fever with Gastrointestinal—Pertaining to the stomach Prevention. This U.S. agency, based in fatality rates ranging from 50 to 90 percent, and intestines. Atlanta, Ga., is responsible for protecting the Ebola has gained public notoriety in books health and safety of people by developing and and movies. Geneva Protocol—The first multinational applying disease prevention and control, covenant to address chemical and biological environmental health, and health promotion Eczema—A condition characterized by weapons, the Geneva Protocol was signed in and education activities. scratchy, itchy, red, dry, blistered and/or 1925. leathery skin. Chemical weapons — Weapons using Gentamicin—An antibiotic used to treat chemical agents to affect the skin, eyes, Encephalitis—Swelling of brain tissues, certain bacterial infections, Gentamicin is circulatory system, nervous system and/or which can be caused by a variety of viral and administered intravenously and is therefore respiratory system. Examples include tear gas, bacterial diseases. less efficient to administer in mass quantities.

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Glanders—A highly lethal bacterial disease Inoculation—Introduction of a vaccine (or in certain diseases, which can then produce a that can kill 50 percent of those exposed. Has other material) into the body. relapse. been developed as a bioweapon and was used against livestock by Germany in World War I. Inversion—A weather condition that can Mad Cow Disease (MCD)—A disease of The CDC lists it as a Category B potential exacerbate the effects of the release of an cattle, it could be used as a weapon to bioweapon. outdoor biological agent, in which a cold produce economic harm. The first U.S. cases layer of air traps warmer air close to the of the disease were discovered in late 2003. Hantavirus—Carried by rodents and mostly ground, preventing vertical mixing of air and transmitted through their droppings, this allowing an aerosol to remain at ground level. Marburg—A viral hemorrhagic fever closely virus causes Hantavirus Pulmonary Inversions generally occur at night, sunrise related to Ebola. Syndrome (HPS), which has now been and sunset, but can persist for days. identified in nine countries. The CDC lists it Melioidosis—A disease caused by the as a Category C potential bioweapon. Iran—One of the nations currently on the Burkholderia pseudomallei bacteria, it is listed State Department’s list of state sponsors of by the CDC as a Category B potential Hemorrhage—Uncontrollable bleeding. terrorism. Iran is presently believed to have bioweapon. Some biological agents cause death primarily large stockpiles of biological weapons, but the through hemorrhaging, including the viral details of its program are unknown. Metropolitan Medical Response System hemorrhagic fevers (VHFs). (MMRS)—This program, originated in 1996, Iraq—One of the nations that was on the was developed to increase coordination at all HHS—Health and Human Services, the State Department’s list of state sponsors of levels in the event of any incident involving federal cabinet-level agency under which the terrorism. Iraq was known to possess large weapons of mass destruction (WMD). CDC, NIH and other agencies are based. quantities of biological weapons during the Managed by the Office of Emergency 1990s, but after the U.S. attack in 2003 its Response (OER), it works with local police, Incubation period—The time between biological weapons program appeared to fire, hazmat, EMS, hospital, public health and exposure to a disease or toxin and the have been terminated and no weapons or other emergency-response personnel in the appearance of the first symptoms. For most facilities for making them were found. In the event of a terrorist attack. potential biological weapons, this can range past, Iraq was known to have developed from a day or two to a month or more. (See weapons using aflatoxin and botulinum. Milling—A mechanical process for Latency). powdering biological agents (bacteria or Isolation—The sequestration of an infected viruses) to produce uniform particles tiny Infection—The invasion of a body by individual to prevent the spread of infection enough to remain aloft in the air for long microorganisms (bacteria, viruses or fungi), to others. periods and be easily inhaled and become which can reproduce in the body to produce lodged in the lung. disease or can remain dormant for long Israel—Israel is believed to have a biological periods. weapons program, but the details are not Monkeypox —An animal disease from known. central Africa, known since 1970 to be Infective, infectious —Capable of causing capable of infecting humans, produced a U.S. infection. Japan—Japan’s Unit 731 used biological outbreak in July, 2003. The transmission was weapons on the Chinese people before and blamed on prairie dogs that were kept as pets. Influenza (flu)—A common viral infection during World War II. The agents used The disease is related to smallpox but with initial symptoms, such as fever, chills, included anthrax, cholera and plague. produces milder symptoms. nausea, cough, that closely resemble those of many biological agents. The resemblance Latency—The period between exposure to a Mycotoxins —Toxins produced by fungi. makes flu a likely initial diagnosis for a disease (bacteria or virus) and the onset of Some, such as Tricothene mycotoxins, have disease actually caused by a bioterror attack. symptoms, or after an initial set of symptoms been used as biological weapons.

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NDMS—The National Disaster Medical form, is thought to be the most likely to be Sarin—A human-made chemical warfare System is a partnership between the U.S. used in a bioterror attack. agent classified as a nerve agent, used by Aum Department of Health and Human Services Shinrikyo in terrorist attacks in Japan. (HHS), the Department of Defense (DoD), Pneumonic—Contracted through the lungs, the Department of Veterans Affairs (VA), as in pneumonic plague or pneumonic SARS—Severe Acute Respiratory Syndrome, FEMA, state and local governments, private anthrax. first reported in early 2003. Although not businesses and civilian volunteers. Its purpose considered a potential biological weapon, it is is to coordinate response to a natural or Psittacosis—A disease caused by the an example of the kind of emerging new terrorist emergency at all levels. Chlamydia psittaci bacteria, it is listed by the diseases that might, naturally or through CDC as a Category B potential bioweapon. genetic engineering, someday become a Nipah virus—A “new” virus discovered in potential weapon. Malaysia in 1999 and closely related to the Pulmonary—Pertaining to the lungs. Hendra virus in Australia. Both of these are Sepsis, septicemia, septicemic —The Paramyxoviridae. It has a high mortality rate Q fever—A bacterial disease, listed by the presence of bacteria in the blood. (50 percent) and is listed by the CDC as a CDC as a Category B potential bioweapon. Category C potential bioweapon. Smallpox—A contagious viral disease that Quarantine—The sequestration or has killed hundreds of millions of people North Korea—One of the nations currently restriction to a given area of individuals who through history, it was the first disease ever on the State Department’s list of state may have been exposed to a disease but have eradicated from natural occurrence in sponsors of terrorism. North Korea is not yet shown signs or symptoms of the humans, with the last natural case in 1977. suspected to have a large stockpile of disease, or those who have developed However, reserves of the disease remain, and biological weapons, but details are not symptoms and must be kept apart from it is perhaps the most feared potential known. others not exposed to the disease. bioweapon.

Nosocomial spread—The contraction of a Rajneeshee cult—The religious cult that Soviet Union—The former Soviet Union had disease while in a hospital. During an deliberately contaminated salad bars with a massive biological weapons program called epidemic, this can become a significant route Salmonella in Oregon in 1984. Hundreds Biopreparat that employed tens of thousands for the spread of disease unless became ill, but no one died. This was the first of scientists and produced mass quantities of countermeasures are carefully followed. incident of biological terrorism in the United a wide range of biological agents. The States. whereabouts of many of the scientists and Orthopox: A family of viruses including many of the samples of biological agents are smallpox, monkeypox and cowpox. Rickettsiae—Bacteria that respond to unknown. It is feared many of the scientists antibiotics but have longer incubation may now be in the employ of nations or Pandemic: When an epidemic spreads periods like viruses and are not contagious. subnational groups seeking offensive throughout much of the world. Rickettsiae include Q fever and typhus. biological weapons programs and may have brought samples of agents with them. Pathogen—Any agent (such as a virus, Ricin—A toxin produced by castor beans. It is bacteria, fungus or toxin) that causes a included in the CDC’s Category B of potential Spores—Bacteria in a dormant, often disease. bioweapons. It was used in mail attacks on a dehydrated form, that can be very resistant to Senate office building in Washington in early degradation by heat, ultraviolet and other Plague—A bacterial infection that can infect 2004, but no deaths resulted. agents that would destroy the living humans and was responsible for the “Black bacterium. Anthrax is one potential Death” in the Middle Ages. It occurs in three Salmonella—A type of bacterium that can bioweapon that could be distributed as an forms: bubonic, pneumonic and septicemic. cause severe gastrointestinal symptoms when aerosol in spore form. Pneumonic plague, the only contagious ingested.

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Stability—The ability of a biological agent to Transmission—The passing of a contagious adverse reactions from the smallpox vaccine. retain its ability to cause disease over time disease from one individual to another. Vector—The Institute for Viral Preparations, and to resist degradation by heat or cold, UV Moscow, known as Vector, is one of only two radiation and other factors. Tularemia—A bacterial infection (Francisella locations in the world officially permitted to tularensis) that is not contagious but is highly hold stocks of the smallpox virus. The other State sponsors of terrorism—The State infectious. Tularemia can infect humans is the Centers for Disease Control and Department’s May 2002 report, “Patterns of through various routes, but the most likely Prevention (CDC) in Atlanta. Global Terrorism,” includes a list of nations route in a bioterror attack is thought to be believed to be state sponsors of terrorism. inhalation of an aerosol. Vector-borne —Illness that is transmitted The list, which has not been updated, through an invertebrate such as an insect. currently includes Cuba, Iran, Iraq, Libya, Typhus fever—A disease caused by the North Korea, Syria and Sudan. Of these, Iraq Rickettsia prowazekii bacteria, it is listed by Viral—Caused by a virus. (now being administered by a multinational the CDC as a Category B potential coalition) and Libya (which has agreed to bioweapon. Viral encephalitis—A viral disease, listed by international inspections) no longer appear the CDC as a Category B potential to belong. Unit 731— The notorious Japanese army bioweapon. unit that used biological weapons such as Streptomycin—An antibiotic used to treat cholera, plague and anthrax on Chinese Viral hemorrhagic fevers (VHFs)—A group certain bacterial infections, streptomycin is people before and during World War II. of viruses that cause internal and external administered intravenously and is therefore bleeding. While some VHFs such as Ebola less efficient to administer in mass quantities. United Nations Special Commission cause severe illness and have high fatality (UNSCOM)—The commission established rates, others cause only mild illnesses. Sudan—One of the nations currently on the in the wake of the Gulf War to oversee the State Department’s list of state sponsors of destruction of weapons of mass destruction. Virulence—The ability of a disease agent to terrorism. After discovering large stockpiles of biological produce illness, sometimes expressed as a weapons, UNSCOM inspections were percentage of exposed people who will Sverdlovsk—The location of an accidental suspended in 1998 when Iraq ceased to develop the disease. release of anthrax from a Soviet bioweapons cooperate, resumed in 2002, and ended in facility in 1979. At least 68 people were killed. 2003. Virus, viruses—Organisms smaller than bacteria and unable to survive on their own, Syria—One of the nations currently on the Vaccine, vaccination—The deliberate which can invade the cells or humans (or State Department’s list of state sponsors of introduction into the body of either a known other species) causing illness and death. terrorism. pathogen, such as a virus or a closely related Viruses can infect humans through a variety form, to create immunity against later of different routes: pulmonary (through the Tabun—A man-made chemical warfare agent exposure. Vaccination is considered the most lungs), cutaneous (through the skin), or classified as a nerve agent. effective public health countermeasure for gastrointestinal (through food or drink). many biological agents. Tokyo—The location of the chemical Vozrozhdeniye Island—The location of a weapons attack by the Aum Shinrikyo cult in Vaccinia—The virus used to create immunity possible test of aerosolized smallpox in 1971. 1995. The cult released the nerve agent Sarin to smallpox in humans. Vaccinia is a relatively Three people died and a mass vaccination into the Tokyo subway system, killing 12. harmless virus closely related to smallpox and effort was undertaken to control the is the origin of the term “vaccinate.” outbreak. Toxins—Poisonous substances produced by many types of organisms, including bacteria, Vaccinia immune globulin (VIG)—A Weaponization—The process of turning a animals and plants. treatment option for people suffering from naturally occurring disease agent into a

50 A JOURNALIST’S GUIDE TO COVERING BIOTERRORISM biological weapon. This usually involves WHO—The World Health Organization, “Worried well”—The term used for people treatments to increase stability, increase headquartered in Geneva, Switzerland, is the who seek medical attention in the wake of a virulence and (for aerosol distribution) primary coordinating body for global health biological, chemical or nuclear attack who are milling to produce tiny, uniformly sized programs and policy. not ill but are concerned they might be. particles.

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